University of Minnesota

Darwin Labarthe on the Epidemiologic Transition

Omran distinguished four phases in the classical model of the epidemiologic transition, each with its own disease pattern.(1)

In the first phase, the age of pestilence and famine, the leading causes of death are “epidemic scourges, endemic, parasitic and deficiency diseases, pneumonia-diarrhea-malnutrition complex in children, and tuberculosis, and puerperal-malnutrition complex in females.”

During the second phase, which Omran called the early phase of the age of receding pandemics, the leading causes of death are “endemic, parasitic and deficiency diseases, epidemic scourges, childhood and maternal complexes. Industrial disease increases.”

By the late phase of the age of receding pandemics, “pandemics of infection, malnutrition, and childhood disease recede; plagues disappear, cholera sweeps Europe in successive waves before disappearing, infection remains the leading cause of death, and non-infectious diseases begin to be more significant.”

In the fourth phase, Omran’s age of degenerative and manmade disease, “heart disease, cancer and stroke replace infection as prime killers. Pneumonia, bronchitis, influenza, and some viral diseases remain problems. Polio rises, then tapers off. Scarlet fever starts to disappear.” (Darwin Labarthe)


  1. A.R. Omran, A.R. 1971. The Epidemiologic Transition: A Theory of the Epidemiology of Population Change. Millbank Memorial Fund Quarterly 49: 509-538.
  2. Kintner, HJ. 1999. Recording the Epidemiological Transition in Germany: 1816-1934. The Journal of the History of Med. and Allied Sc. 54: 167-189.