Richard K. Thomas

Morbidity and Mortality

Of all demographic factors, morbidity and mortality represent the clearest linkage between demography and health care. In a general way, they represent both the level of need and the extent of the effect of the functioning of the health care system. Morbidity, or the level of sickness and disability within a population, historically has been an area of study for both clinicians and population-oriented scientists such as epidemiologists. In recent years, however, increased activity on the part of demographers has been observed as population researchers apply their methodologies and perspectives in greater detail and with more precision to the study of sickness and death. Mortality refers to the process of death characterizing a population and its study includes the characteristics of those who die as well as what they die from. It is a more traditional focus of demographers, in part because of its direct effect (along with fertility and migration) in bringing about population change.

Population Size, Distribution and Concentration

The size of the population within a geographic area – typically measured in terms of the number of people – is the simplest and most straightforward of demographic attributes. And, for many purposes, it is the most important. Not only is the size of a population important in its own right, but many of the calculations utilized in determining healthcare needs and health services demand depend on this information. After size, the pattern of distribution and concentration of persons within a geographic area probably is next in importance for anyone examining the interface of demographics and healthcare.

Health Demography: An Evolving Discipline

Health demography is a subdiscipline within the field of demography that involves the application of the content and methods of demography to the study of health and healthcare. Demography, or the study of human populations, focuses on the study of the size, distribution, and composition of populations, as well as related dynamic processes such as fertility, mortality, and migration. Health and healthcare refer, respectively, to the condition of health as experienced by individuals and populations and to the operation of the healthcare delivery system. Health demography concerns itself with the manner in which demographic attributes influence both the health status and health behavior of populations and how, in turn, health-related phenomena affect demographic attributes. Health demography shares an interest in individual-level health issues with clinical medicine and in population-level health issues with social epidemiology.

Demographic Correlates of Health Behavior and Health Services Utilization

This chapter focuses on the relationship between various demographic characteristics and the response of individuals and groups to health-related conditions. Chapter 10 examined the demographic correlates of health status, and this chapter represents a natural extension of that discussion. Health behavior might be broadly defined to include formal health services utilization as well as the informal health behavior characterizing the population. Some of these actions are taken by individuals who have been formally diagnosed as ill. However, much health behavior is carried out by relatively healthy individuals who are attempting to maintain or enhance their existing health status or to prevent a decline in health status.

International and Internal Migration

Geographic mobility, or migration, is the third component of population change. Migration is the most dynamic and complex of the three population components. Moreover, it is the most difficult to measure. While death occurs only once and the average number of births per woman in the United States today is about two, the occurrences of migration are much more frequent. The average U.S. resident will move more than twenty times in his or her lifetime (Bailey and Sly 1985). About 17% of the population changes residence each year, and over a five-year period, more than 45% of the population moves.

Are Americans Getting Sicker? An Analysis of Emerging Morbidity Trends

The improvement in the health status of the U.S. population during the 20th century is well documented. Over that century dramatic reductions were recorded for mortality rates (most notably for infant mortality and maternal mortality ), life expectancy markedly increased, and many killer diseases were eliminated as health threats. Americans became healthier as a result of higher standards of living, expanded public health functions and better diets. By the 1980s, however, observers began noting anomalies in the available data that suggest the trend toward improved health was moderating and the occasional piece of evidence that the trend was actually being reversed. By the dawn of the 21st century a growing body of evidence suggested that, in fact, Americans may be getting sicker. It would certainly be a noteworthy development if this adverse trend could be verified. However, a number of factors make it very difficult to determine if a reversal of America’s health fortunes are taking place. This paper addresses the challenges involved in definitively measuring trends in health status, reviews the evidence for declining health status, and considers the possible conclusions that can be drawn.

Demographic Correlates of Health Behavior

This chapter focuses on the relationship between various demographic characteristics and the response of individuals and groups to health-related conditions – that is, their health behavior. Chapter 10 examined the demographic correlates of health status, and this chapter represents a natural extension of that discussion. Health behavior might be broadly defined to include formal health services utilization as well as the informal health behavior exhibited by a population. Some of these actions are taken by individuals who have been formally diagnosed as ill. However, much health behavior is carried out by relatively healthy individuals who are attempting to maintain or enhance their existing health status or to prevent a decline in health status.

Health Demography and Public Policy

The interface between demography and healthcare at the policy level is reflected in both population policies and health policies. In fact, it is difficult to separate population policies and health policies due the impact they have upon each other. The enactment of healthcare policies will inevitably have implications for the demographic processes of the society, affecting fertility levels (e.g., through abortion policies), morbidity patterns (e.g., through health insurance coverage), and mortality (e.g., through research funding priorities). Healthcare policies may even affect immigration patterns, as in the case of now-abolished policies prohibiting the immigration of people infected by AIDS.

Data Sources for Health Demography

The health care industry has always presented something of a paradox. Although historically awash in data, it has been very difficult to convert these data into usable information. Health data have often not been very accessible even to the organizations that generate the data. When data sets have been accessible, they typically have been of limited use to health demographers and other analysts, since they were usually generated for some operational or administrative purpose. Further, even when data have been made accessible, the tools were not available for their efficient management and exploitation.

Health and Healthcare: An Introduction

Health demography focuses on the implications of population characteristics for health and healthcare. However, as central as these concepts are to our discussion, they are surprisingly difficult to define, despite the obsession of American society with both of these concepts. What constitutes health – and its counterparts sickness, and disease – depends on one’s frame of reference. Although the term health clearly refers to a condition of human individuals and populations, there is no consensus on a definition. Medical sociologists studying the meanings of these terms have had to settle for several definitions, each linked to a different explanatory model. The various definitions and the perspectives they represent will be discussed later in this chapter.