The epidemiologic transition in Peru.

In 1971, Omran formulated the epidemiologic transition theory (1), which builds on the demographic transition theory but also includes the changing patterns in diseases and the causes of death. He recognizes that the epidemiologic transition of non-industrialized societies differs fundamentally from the epidemiologic transition in the developed (Western) world (2). Omran's non-Western transition model describes the epidemiologic changes over time in developing countries in terms of three stages: " the age of pestilence and famine, " " the age of receding pandemic, " and " the age of triple health burden " (2). This paper explores the epidemiologic transition in Peru. Peru is situated in western South America, between Chile and Ecuador and bordering the Pacific Ocean. Peru has a population of 27 million people (3) and a total area of 1 285 215 km 2 (4). There have been some major changes in the country's health situation in recent decades. For example, average life expectancy at birth increased from about 44 years in the early 1950s to almost 70 years in 2002 (5). Also making Peru an interesting case study is the fact that the country has three totally different geographical regions: the coast (costa), the Andean highlands (sierra), and the Amazon jungle (selva). These regions differ from each other with regard to their ecological systems and climate, their socioeconomic status, and their culture. Peru has 25 departments , which are the country's main administrative units. These departments are categorized into five poverty strata, with stratum I being the richest and stratum V the poorest (6) (Table 1). The richest departments are in the coastal region. Peru's diversity in geography and economic status is also reflected in a diversity in health status within the country. For this study six key Peruvian experts were interviewed and an extensive literature and data search was conducted in order to obtain relevant information on the past and present health situation in Peru. With respect to the availability of both historical health data and current health data, it is important to note that Peru has had an incomplete registration of health information. For example, estimates of mortality before 1950 are difficult to obtain , and current mortality rates are still corrected for underregistration, since nearly 50% of all deaths in Peru go unregistered (4). However, the Pan American Health Organization (PAHO) concluded in 1962 that the available mortality data still gave a sufficient basis …