The required health service mix would remain the same, with an expectation of a diminished demand given the reduced population. The population would have shrunk, but the demographic profile of the population would remain constant. If for instance, the migration of people away from rural areas were represented proportionately across the age groups then the demographic profile of the rural community would remain exactly the same before and after migration. However, relatively little is known about how well health systems adjust to urbanisation with respect to the provision of services to rural communities, particularly in the context of low and middle income countries. There has been significant research undertaken on the effects of urban growth and the implications for health systems and health care. ![]() For individuals the move to urban centers is often driven by family interests or a personal desire to seek one's fortune where there is a greater diversity of opportunities and greater earning potential. A World Bank publication highlights that “no country has ever reached middle-income status without a significant population shift into cities”. As a strategy for implementing development agendas, urbanisation has been a consistent trend in low and middle income countries. Also important is the monitoring of the distribution of populations across urban and rural areas as an indication of urbanisation and internal migration patterns. Demographic information is therefore critical to priority setting for preventive, promotive, curative and rehabilitative health care services and the allocation of resources to meet the needs of the various sectors of the population.ĭemographic transitions monitor the changes in the population profiles over time, providing an indicator of economic and industrial development. Countries with a higher proportion of older people will require a proportionately greater investment in health services for the aged, catering particularly for the chronic non-communicable diseases (NCDs) prevalent in later life. Higher income countries have stationary or more commonly, constrictive population pyramids which indicate similar proportions across ages, or negative growth and aging populations respectively. This usually indicates a high fertility rate and therefore a greater need for reproductive health programs and infant and child health services. Most low and middle income countries for instance, have a classic expansive population pyramid which depicts a 'youth bulge' or a greater proportion of younger people. The demographic profile therefore is an important indicator to inform disease priorities. The demographic profile of a country indicates the risk groups across age, sex or ethnicity related risk factors. Community based population monitoring provides critical information to inform health systems.ĭemographic and epidemiological transitions are necessarily correlated. The relatively greater number of older people in the rural population suggest a very different health services mix need. The health services needs of an older population will tend towards chronic conditions, rather than the typically acute conditions of childhood. ![]() In the older age group, however, the rural sub-district shows twice the need for services as the national data indicate. Resultsīased on the population profiles and the dependency ratios, the rural sub-district shows need for health services in the under 14 age group similar to that required nationally. ![]() The population pyramids, and the dependency and support ratios for the whole population and the SEACO sub-district population are compared. Approximate Malaysian national age and sex profiles were downloaded from the US Census Bureau. MethodsĬensus data were collected from 10,373 household and the sex and age of household members was recorded. This is examined using data from the South East Asia Community Observatory in rural Malaysia and contrasting it with the national Malaysia population profile. ![]() As a consequence, the kinds of services required for an urban population may be quite different from that required for a rural population. In many low and middle income countries, the rate of urbanisation can leave the profile of the rural population quite different from the urban population. Health services can only be responsive if they are designed to service the needs of the population at hand.
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