Health transitions: Jack Caldwell’s on-going legacy at NCEPH

Prof Caldwell brought to NCEPH his Rockefeller Foundation funded Health Transition Centre which operated for 8 years

One of the founding influences for NCEPH was the leadership provided early on by Associate Director Professor John Caldwell, who in 2012 was voted by his peers as the most influential and respected demographer of all time[1]. Prof Caldwell brought to NCEPH his Rockefeller Foundation funded Health Transition Centre which operated for 8 years and was connected to a 7-volume review journal, The Health Transition Review. The Health Transition as described by Prof Caldwell refers to the cultural, social and behavioural determinants of health, as favourable social change interacts with modern medical care to produce optimum health and minimum mortality.

Prof Caldwell retired in 1996. Several years later his ideas underpinned a Wellcome Trust and NHMRC funded project to study the health transition directly in a regional setting where rapid change was underway (Thailand).  This project began in 2004 and is led from NCEPH as a large longitudinal study including a cohort of over 80,000 Thai adult Open University students residing all over the country. This epidemiological field study investigates multi-level changes in exposure as causal determinants of transitions in health (a “health-risk transition”). Examples include transition from infectious diseases, maternal mortality and short life span to longer life span and chronic diseases such as diabetes and hypertension. Other transitions relate to changing transport and injury risk (eg motorcycles), changing diets and physical activity associated with emerging obesity, and increased sexual partnering among youth and consequential increase in unplanned pregnancy.   

Thailand is an important regional member of Southeast Asia and has shared borders and close contact with more Southeast Asian states than any other. The research in Thailand is centred on a national university with huge enrolment – Sukhothai Thammathirat Open University. Thus the research covers a wide range of the Thai population and has regional implications. Because cohort members are well educated the 8-year follow-up has been able to gather sophisticated information on social demography, diet, physical activity, injury, fractures, wellbeing, mental health, oral health, disability, caring, alcohol intake and tobacco use, contraceptive use and doctor-diagnosed disease.

The Thai Health-Risk Transition research project has been a major vehicle to build collaborative international research capacity at NCEPH (8 PhDs, 2 Honours degrees, 3 post-docs, 3 medical student practicums) and additional capacity in Thailand (3 PhDs, 8 Master degrees). As well the project has been productive in research investigating a wide array of transitional environmental, economic, occupational, cultural, social and health system determinants of diverse and rapidly evolving population health outcomes. At the beginning of its 10th year the project had produced 70 peer reviewed publications and numerous books, book chapters and conference presentations providing modern analysis of topics important in Southeast Asia. The Health Transition as conceived by Prof Caldwell is fundamental to interpretive discussions connected to this Thai research.

Article by Professor Adrian Sleigh

[1] van Dalen HP & Henkens K (2012) What is on a demographer’s mind? A worldwide survey. Demographic Research, 26; 363-408.


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