CHAPTER 4

DATA ON POPULATION AND MORTALITY

1. Reading Focus

A. Before you read

1. Do you think that data on the birth and death of population is necessary?
Why?

2. Where can we obtain the data?

3. What kind of data can be used to make a decision on population helath?

B. Read the following text.

In public health, we want to understand what is happening to a population’s

health over time. There are several potential sources of information that can
be used to do this. For example, one might think of using data on admissions
to hospital, or use of health services. Unfortunately, these tell us very little
about disease burden. Instead, they tell us about those who have a disease
and then, for whatever reason, use health care facilities (at least those that we
have information about – a problem in many health care systems with mixed
systems of provision). Specifically, they tell us nothing about those people
who may have disease or disability but do not seek care. For this reason, the
following paragraphs will focus on the basic factors that can help one
understand a population’s health: deaths and population at risk.
1. How many people, and why are they dying?
Mortality data are a fundamental source of information on the health of a
population. Because of their generally widespread availability and

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timeliness, they are widely used to describe and monitor major public health
issues, including the progression (and decline) of chronic diseases, the
emergence of recent threats to health such as HIV/AIDS, or the evaluation of
public health interventions.
In order to be able to interpret mortality data you need two types of
information. First, and most obviously, you need to know how many deaths
have occurred, among whom, and from what. Second, and often forgotten,
you need to know the composition of the population.
a. How many people are dying?
Vital registration of death exists in about 70 countries worldwide. In a few
others, such as India and China, there are sentinel surveillance systems
covering some parts of the population. Death certification is often based on a
standard certificate on which the age, sex and cause of death of the deceased
is recorded along with various other pieces of information (for example,
gender, age, marital status, occupation, educational achievement, income,
address, and so on) which vary from country to country. In some countries,
the section describing the cause of death has to be completed by a doctor, or,
if the death happened as a result of an accident, suicide or homicide, by the
police or a coroner.
Cause of death is recorded using a classification developed by the
World Health Organization, the International Classification of Disease
(ICD). This classification is regularly updated to take account of changing
patterns of disease, such as the emergence of AIDS. Most countries changed
to the tenth revision of the ICD in the late 1990s, having used the ninth
revision from about 1979. The ICD is divided into a series of chapters, such
as II for ‘Neoplasms’ or IV for ‘Endocrine, nutritional and metabolic
diseases’. In the tenth revision each individual disease is given a unique
alpha numeric code. For example, cancer of the stomach is C16, which can

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be subdivided to give more precise localization (C16.2 is cancer of the body
of the stomach).
Clearly, many people die from a combination of disease processes
and death certificates generally provide space for multiple causes (this is
particularly important for older people who are more likely to have multiple
causes of death). However, summary statistics usually report a single cause,
which is selected according to standardized procedures that aim to identify
the ‘underlying cause of death’. In those countries where it is possible to
obtain data with multiple causes of death, the scope for analysis is clearly
increased.
While death registration data are generally more complete and
reliable than many routine sources of morbidity data, several issues need to
be taken into account when interpreting cause of death data. Diagnosis is
inevitably an inexact science and comparison of causes of death certificates
with those determined by autopsy often find disagreements. One reason is
that, especially in patients presenting with advanced disease, it may not be
considered appropriate to undertake invasive investigation just to confirm a
diagnosis when there is no prospect of cure. Another issue is the effort put
into attributing cause of death by the certifying doctor. Systematic
differences have also been noted in the choice of diagnosis given by a
physician depending on the social class of the patient or the gender of patient
and doctor. A further problem arises when deaths are compared between
countries, or compared over time where they may span more than one
revision of the ICD. There are, however, bridging tables to inform
comparisons over time.
In developing and middle-income countries, where vital registration
systems are often poorly developed, it may be possible to get information
from surveys. The most widely used example is the series of Demography

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and Health Surveys (DHS) that are conducted every few years in many
countries. They are, however, limited in their coverage to childhood and
maternal events.
b. How many people are there in the population?
Although knowing about the numbers of deaths from different causes is
essential to assessing a population’s health, they have very little meaning in
themselves. They only become useful when divided by the number of
persons in the population.
The most common method used to find out how many people there
are in a population is the census. Censuses have been conducted throughout
recorded history, often for military or tax purposes. However, systematic
modern censuses have their origins in Western Europe in the nineteenth
century. Typically undertaken every ten years, they now usually include
information on age, sex, marital status, employment and a varying selection
of other factors.
Carrying out a census is an enormous undertaking. For this reason,
there are still many countries throughout the world where there have been no
censuses, or ones covering only urban populations, for several decades. The
only country never to have conducted a census is Chad. On the other hand, a
few advanced industrialized countries, such as the Netherlands and
Germany, have abandoned censuses. This is because they have population
registers (for example, requiring everyone to register with local government
when they move house). These countries are thus obtaining information on
their population from the continually updated population and other registers
rather than from censuses.
In an increasingly mobile world, the challenges of undertaking
censuses are growing and censuses can rapidly become out of date. In some
cases, certain population subgroups are especially difficult to reach. For

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example, in the 1991 British census it was estimated that a million people
were missed. In some parts of the country, such as inner London, the figures
are thought to be especially high. Censuses are also susceptible to
misreporting by respondents. In particular, the elderly tend to overstate their
age, divorced men tend to report that they are single (never married), and all
people tend to inflate their socioeconomic status. In addition, especially at
older ages, there is a tendency to give one’s age to the nearest five years,
causing the phenomenon known as ‘heaping’. For these reasons, especially
when undertaking analyses involving small populations, it is necessary to
take care when interpreting results.
C. Answer the following questions based on the text.

1. Mention potential sources of data to understand what is happening to

population’s health over time.

2. Why are mortality data a fundamental source of information on the health

of a population?

3. What do you need to interpret mortality data?

4. Who describes the causes of death in some countries?

5. What is “International Classification of Disease (ICD)”?

2. Vocabulary Focus

A. Complete the blank spaces with the words in the box.

companionship (=persahabatan) infancy (=masa kecil)

adolescence (=masa remaja) well-being (=kesejahteraan)
achieved (=mencapai) attitude (=sikap)
value (=nilai) cope (=menangani)
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1. It is a relief to have _______our goals.

2. She clearly has a good _______ towards health and fitness.

3. After being hospitalized for a few weeks, he realized the ________ of

health for his life.

4. I think he missed the _____ of his colleagues in a clinic.

5. His ______ was not a happy time for him. He was abandoned by his father

at the age of 15.

6. We must try to _____with our stress.

7. There are a number of factors which affects our_______, one of which is

the degree of our health.

8. He came to Jakarta in his ______, around five years of age.

3. Grammar Focus

PASSIVE VOICE

A. Study the following sentences :

1. All medicines are dangerous if they are used wrongly.

2. Human waste is normally controlled by the use of latrines.

3. Many disease are spread by bad sanitation.

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 The sentences above illustrate the passive voice. The passive voice is
used when writing scientific or official reports and when describing various
processes, incidents, situations or conditions. In the passive , the object of
the active sentence becomes the subject of the passive sentence . In the
example below, the object “children” becomes the subject of the pass ive
sentence, the subject “paediatricians” becomes the object preceded by
“by” (“by paediatricians” ) and the verb “treat” in the active sentence
becomes “be past participle/verb III” (“are treated”) in the passive
sentence.

Paediatricians treat children.

Children are treated by paediatrician.

B. Change the following active sentences into the passive form.

1. Tina eats a balanced diet.

________________________

2. Cholesterol precipitates heart problem.

____________________________.

3.The body store glucose in the liver and muscle.

_______________________.

4.The nurse gives an injection to the patient.

_____________________________.

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5. Every morning the student nurses sponge the bedridden patients.

___________________________________

6.The nurse assists the patient to do elimination.

_____________________________________.

7. My children always wash their hands before eating something.

The hands _____________________________..

8. My mother always accompanies my ailing father to the hospital.

______________________________________

C. Fill in the blanks with the correct passive forms of the verbs in
brackets.

1. Rani ______(give) a 500mg Ampicilin injection six hourly.

2.These procedures _____normally _____ (perform) by doctors.

3. Tia’s medical report shows that these symptoms are due to anemia which
____(cause) by iron deficiency.

4. Children under eight ____ (exclude) from the category of juvenile

delinquency.

5. Most infectious diseases _____(cure) by the correct use of drugs and

medicines.

6. In many countries medicines ______(sell) freely without a doctor’s

prescription.

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7. The problem of bacterial resistance ______ (find) with TB, typhoid and
many other serious diseases.

8. Some disease microbes _____ (transmit) by insects.

4. Communication Focus

A. Learn and practise the conversation below.

J: Hello.

B: Oh, hi, Joan. It’s Betty. How are you doing ?.

J : Terrible.

B : Oh, what’s the matter ?

J : I’ve got a fever and a bad headache.

B : Oh, that’s too bad. Why don’t you take some aspirin ?

J : I’ve already tried that. But it didn’t help.

B : Well, maybe you should see a doctor.

J : Yes, I guess so.

B. Ask your partner what’s wrong, express symphaty, and suggest

something to help. Follow this model.

A : Hi, _______. How are you ?

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B : Not so well, I am afraid.

A : Really ? What’s ________ ?

B : I’ve got a(n) ________.

A : Oh, __________. Why don’t you ______ ?

B : I’ve already _________.

Student B Student A

1. Fever take an aspirin

2. Sore throat try lozenges

3, Bad cough take cough medicine

4. Sore shoulder try rubbing alcohol

5. Earache try ear drops

6. bad cold take cold capsules

7. stomachache take bicarbonate

8. headache take aspirin

5. Writing Focus

Make a presentation on “Data on Population and Mortality” on no longer

than six slides summarizing main points of the text above. After that, deliver
your presentation in groups.

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