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# demography

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# demography

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### demography

1. 1.  Define demography and recognize its importance and methods of study.  Describe population estimations in the census and inter-census years.  Describe & interpret different profiles of the population pyramid  Categorize data sources for vital statistics  Differentiate between proportion, ratio, and rate.  Calculate Vital indices [fertility - birth, morbidity (disease) –death (mortality)].  Recognize the relationship between MDGS & vital indices
2. 2. 3 Demography  It is the study of population characteristics, size or number, structure, geographical distribution as well as the changes of these determinants over time.
3. 3. It is very important to public health as it provides:  The number of population to be covered by health services,  The amount of vaccines or drugs needed every year,  The characteristics of population in different geographical areas that can affect health,  Data necessary to calculate health indicators (used in comparison, planning, evaluation and prediction of community health services and programs) Value of demography
4. 4. I- Size (census & Intercensus) II-Population growth pattern (RNI) III- Composition (Population pyramid) V-Health indicators IV-Population distribution (maps)
5. 5. I-Population census Def. To enumerate people in certain area (country) at certain time It collects data about:  the number of population,  characteristics as age, sex, and socio-economic data as income, crowdness index, occupation, education level etc..  Census is done every 10 years since it is time, effort and cost consuming.  Mid-year population is the number of population calculated from census at the 1st of July (it was chosen as a standard for any census).
6. 6. I-Population census What is Importance of census:  Calculate the actual number of population living in that country at the year of census.  For planning for future health care programs.  Provides general characteristics of the population used in comparison over periods of time, or comparison with other foreign populations.  To estimate population in years between censuses.  Calculate vital statistical rates.
7. 7. I-Population census Drawbacks of census:  Expensive, needs time, money, personnel. As it needs long time in data collection and analysis the results will be irrelevant i.e census is done in 2006 and results announces in 2010.  Data may be inaccurate: People tend to round their age because they do not know their birthday exactly. People hide their real income and others hide the actual number of children they have.  There are some areas where people are moving . They are missed or under-estimated.  Lack of co-operation between people and census data collectors.  Data collectors may fill questionnaire by themselves when houses are empty.
8. 8. Inter-census Population Certain methods are used to calculate the number of population at years in between census.
9. 9. Estimation of population in Between census
10. 10. if we need to estimate population number at 1994  we deduce population census at 1990 from that at 2000 (difference between 2 subsequent censuses)  then divide that difference by 10 (to find the annual increase of population) multiply this annual increase by 4 to get the increase in 4 years.  Add the result to population number in census 1990 to get population number in 1994. This method presume that population increase yearly with the same amount which is not true. Inter-census population
11. 11. Census 1990 = 60 millions 2000 = 80 millions 1994 ? Census 2000 - census 1990 80 - 60 = 20 millions Annual increase of pop.= 20 / 10 = 2 millions Pop. Increase in 4 years = 2 x 4 = 8 millions Pop. Number in 1994 = 8 + 60 (pop. 1990) = 68 millions
12. 12.  is the difference between crude birth rate and crude death rate which is considered as the number of population added per year.  Multiply this increase by the number of years (e.g.4 for 1994) then added to the census of 1990 (as the previous example).  This method neglects the migration factor that can increase/decrease population number whether to or from the country. Inter-census population
13. 13. RNI = crude Birth rate - crude death rate = number of pop. Added / year (Annual increase of pop.) Pop. Increase in 4 years = x 4 = ---- millions Pop. Number in 1994 = Pop. No. in 4 years + 60 (pop. 1990) = 68 millions ------------------------ Crude Birth rate = No. of live births / mid year pop. X 1000 1994?
14. 14.  It equals (crude birth rate + immigrants to the country) minus (crude death rate + emigrants outside).  Then estimated population is calculated in arithmetic way as previous. Inter-census population
15. 15.  By plotting a straight line connecting population numbers in all previous censuses (x-axis represents years of censuses) and (y- axis represents population number in million).  We can know from that graph the estimated population number in years between 2 censuses  also we can predict the number of population in the future by extending the line. Inter-census population
16. 16. 120 100 80 60 40 20 0 1990 2000 Graphic method No Of Pop. 2010 1994 y 1996
17. 17.  It is calculated by certain equation that depends on the last two population censuses, the number of years in between censuses and the annual rate of increase.  This method assumes that population growth is not linear (or steady every year). Inter-census population
18. 18. 1- The census of Egypt in 1996 was 60 millions, while in the year 2006 was 75 millions. Calculate the expected population number in the year 1998 and 2004 by two different methods.
19. 19. 1-Arithmatic method: Census2006 – census 1996 =75-60=15 million Annual increase= 15milion/10years= 1.5million Census at the year 1998=60+2X1.5=63 million Census at the 2004=75-2X1.5=72 million 2-Graphic method:
20. 20. 120 100 80 60 40 20 0 1996 2006 Graphic method No Of Pop. 1998 y 2004 72 m 63 m
21. 21. I- Size (census & Intercensus) II-Population growth pattern (RNI) III- Composition (Population pyramid) V-Health indicators IV-Population distribution (maps)
22. 22. II-Population growth pattern Changing population growth pattern (transition) is mainly affected by: births, deaths, migration (in some countries it is an important factor) and life expectancy. The process of a change in society’s populations from a condition of high birth rate and death rate and low RNI to a condition of low birth rate and death rate and low RNI and even to negative growth (can be described by 5 stages).
23. 23. More healthcare/education/empowered women Amazon population Ethiopia India UK Germany Birth rate High and fluctuating High and steady Rapidly decreasing Low and fluctuating Slowly falling Death rate High and fluctuating Rapidly falling Slowly falling Low and fluctuating Low and fluctuating Population growth rate Zero Very high High Zero Negative Population size Low and steady Rapidly increasing Increasing High and steady Slowly falling
24. 24. Life expectancy: is the average number of years that can be expected to be lived by any individual at certain age.  Life expectancy is directly proportional to country development, socio-economic level, health services standard, use of new technology, good nutrition, healthy environment, literacy etc.  In developed countries the life expectancy of new borne is 85 years while in under developed countries it reaches 40 years.  In Egypt, life expectancy at birth (72.7 years) 2016 (Males 71.4 years) (Females 74.2 years) II-Population growth pattern
25. 25. I- Size (census & Intercensus) II-Population growth pattern (RNI) III- Composition (Population pyramid) V-Health indicators IV-Population distribution (maps)
26. 26. III-Population pyramid  It is a graphical presentation of population by age and sex (Histogram).  Vertical axis represents age groups(in five years) and  the horizontal axis represents percentage of population of these age groups in relation to sex. Characteristics of the population pyramid :
27. 27.  Base of the pyramid represents the birth rate.  Height represents the number of years to be lived at specific age.(life expectancy)  Top represents the percentage of old age groups.  Slope of the pyramid represents the age specific death rates.  Dependency ratio: is the number of young ages below 15 years old plus the number of old ages over 65(who are dependents) per 100 persons from 15 to 64(who are independent).  Percentage of males and females at each age group.
28. 28.  Total Dependency ratio: is the number of young ages below 15 years old plus the number of old ages over 65(who are dependents) per 100 persons from 15 to 64(who are independent). In Egypt = 62.3% (2016)  Youth dependency ratio: is the number of young ages below 15 years old per 100 persons from 15 to 64(who are independent). In Egypt = 53.8% (2016)  Elderly dependency ratio: is the number of elderly people > 65 years old per 100 persons from 15 to 64(who are independent). In Egypt = 8.5% (2016)
29. 29. Definition Percentage Percentage
30. 30. 1- Birth rate 2- Life expectancy 3- Old age group 5- Dependency ratio= No of dependents/ No. independents 6- Percentage of males and females at each age group Characheristics
31. 31. Wide base Short height Expansive model Rapid growth
32. 32. Population pyramid
33. 33. Pop.Pyramid 1950 Pop. Pyramid 2000 Pop. Pyramid 2050 Base is wide Egypt
34. 34. It follows the expansive type of model, where:  1. The base is wide due to high birth rate,  2. Tapers rapidly due to high specific death rates especially 0 to 5 years,  3. The top is narrow due to low proportion of elderly.  4. The height is short due to short life expectancy. Population pyramid
35. 35. it shows an expansive type (stage 2), where:  1. The base is less than that of the 1950 due to decrease in birth rate.  2. Fertility decline is evident by that the proportion in the age period 0-4 and 5-9 are less than that in the period 10-14  3. More decrease in the different age specific death rates,  4. Life expectancy has increased  5. Old age group increased.  Population pyramid
36. 36. It is expected to be of a Stationary type, where:  1. The different age group proportion will be almost equal due to almost equal birth and death rates  2. There a slow tapering at old age due to expected low age specific death rates. More flat top due to expected increase in elderly sector.  3. Longer life expectancy may reach 80 years. 
37. 37. I- Size (census & Intercensus) II-Population growth pattern (RNI) III- Composition (Population pyramid) V-Health indicators IV-Population distribution (maps)
38. 38. IV-Population distribution (maps)
39. 39. Show Desktop.scf Population Distribution in Egypt . 95% of pop. Nile (5%) Pop. density is Very high
40. 40. V-Health indicators What are the values of health indicators? 1- Describing and diagnosis of community health problems. 2- Comparing different countries at the same time or changes in a country at different times. 3- Planning of health services and programs. 4- Evaluation of community health services and programs. 5- Prediction of future health needs of the community.
41. 41. What are the health indicators used???  (Vital rates): birth, fertility, death, and morbidity.  Annual economic growth rate  Per capita income  Literacy percentage  Dependency ratio  Life expectancy IV-Health indicators
42. 42. Health indices (vital rates) What are the vital indices???  Vital indices are quantitative measures that describe and summarize vital events in the human life e.g.: Human life Marriage Fertility Diseases Migration Birth Death
43. 43. Ratio:  The relation between two unrelated events e.g. male to female ratio is 1:2. Black to white ratio is 2:3. Definitions
44. 44. Proportion:  Numerator part of the denominator Percent: When the base is 100. Definitions
45. 45. Rate: the frequency of an event in a population in relation to time e.g. birth rate means the number of births occurred in population during a year (or month). N.B. The rate is usually multiplied by a constant as 100 or 1000 to get an integer number.
46. 46. 4-Mortality 3-Morbidity 2-Fertility 1-Birth CBR CBR GFR ASFR TFR FR GRR NRR Incidence Prevalence Attack Case fatality CDR ASMR ASSMR Cause sp.MR Proportional MR
47. 47. A-Crude birth rate (CBR)  CBR= number of live births/ mid year population X 1000 in a given year and locality. Advantages: CBR describes the increase in population over time, simple & easy to know birth number (birth registries) and population number at any time (from census), Disadvantages: it is not specific for comparison between countries because the denominator is the whole population. The rate must exclude men , young girls, unmarried, infertile, and menopausal women.
48. 48. A-Crude birth rate (CBR) in Egypt  CBR (1990) = 33.5 births / 1000 population CBR (2010) = 23 births / 1000 population CBR (2014) = 27.8 births / 1000 population CBR (2016) = 30.3 births / 1000 population
49. 49. B-Fertility indices:  Fertility is the reproduction performance of a population.  Fertility indices include: 1. CBR 2. General Fertility Rate (GFR) 3. Age-Specific Fertility Rate (ASFR) 4. Total Fertility Rate (TFR) 5. Fecundity Rate (FR) 6. Gross Reproduction Rate (GRR) 7. Net Reproduction Rate (NRR)
50. 50. 2-General Fertility Rate (GFR):  GFR=number of live births/number of women (from15 to 49years) X1000. In the same locality and year  Since, women in the reproductive age constitutes about 25 % (1/4) of the population,  therefore the GFR is considered to be about 4 times the crude birth rate. B-Fertility indices:
51. 51. 2-General Fertility Rate (GFR): Advantages: GFR is a more accurate index than the crude birth rate because: 1. It is related only to females in the reproductive age, 2. It is more suitable for comparison between countries since it eliminates difference in sex composition Disadvantages: 1- it doesn’t consider that not all females in the reproductive age are married and fertile 2-it did not consider the difference in females’ age distribution in different countries. B-Fertility indices:
52. 52. B-Fertility indices: 3-Age-Specific Fertility Rate (ASFR):  It is calculated for every five years of the reproductive age of woman. It is important for differentiating between fertility behaviors at different age groups.  ASFR (15 - < 20) =Number of live birth borne to mothers from 15 to 20 years old / number of women of the same age(15-20 years) X1000. In certain locality and year  Therefore there are seven ASFRs (every five years) for all women in reproductive period.
53. 53. B-Fertility indices: 3-Age-Specific Fertility Rate (ASFR):  Advantages: It is a better index than the general fertility rate as it takes into account the difference in age distribution of female in different areas and the degree of fertility in each age group.
54. 54. B-Fertility indices: 4-Total Fertility Rate (TFR):  It is the number of children that would be born to a woman if she passes through her child bearing period following the age specific fertility rates in a given year and locality.  TFR in Egypt (2016) = 3.5 children / woman
55. 55. B-Fertility indices: The Total fertility rate (TFR ) is calculated as: TFR = ∑ ASFR (for single year age groups) TFR = 5 ∑ ASFR (for 5-year age groups)
56. 56. TFR Calculation (Practical example) Estimate of the average annual TFR for all women aged 15-49, Egypt, 1997-2000. TFR= 5 (.051 + .196 + .208 + .147 + .075 + .024 +.004) = 3.53 Where: the figures in parentheses are age-specific rates for the 15-19, 20- 24, ... , 45-49 age categories, respectively.
57. 57. B-Fertility indices: 5-Fecundity Rate (FR): It is the number of live births born per thousand married women in a certain locality and year. Advantages: It is better index than the general fertility rate as it includes only married women.
58. 58. B-Fertility indices: 6-Gross Reproduction Rate (GRR):  The GRR includes only born females, (expected to be future mothers) per 1000 women in the childbearing period.  GRR = Total Fertility Rate X Proportion of females in relation to total birth.  In Egypt, it is estimated to be 1.5, which means that every woman will give birth to 1 to 2 women during her childbearing period.  Disadvantages: it did not consider the possibility of death of women during their child bearing period.
59. 59. B-Fertility indices: 7-Net Reproduction Rate (NRR):  It takes into consideration the deaths of women during their child bearing period using life tables of females.  NRR = Gross Reproduction Rate X Life expectancy of females during childbearing period from life tables.  Advantages: It is the best measure of fertility.
60. 60. 1-Age and sex structure of the population: The larger the number of women in the childbearing period in a certain population the higher is the fertility level in such population. 2-Age of marriage: The younger the age of marriage the higher is the fertility. 3-Socioeconomic conditions: Higher economic status, higher status of women and higher level of education are associated with low fertility rates.
61. 61. 4 -Fecundity: The physiological capability of couples to reproduce it is affected by their health conditions. 5- Fertility Motives: Fertility motives are the reasons that motivate a couple to increase or decrease the number of children they will have. Several motivations explain such attitude:
62. 62. 1- Economic motives: If the children are becoming a source of income to the family, this will lead to the desire of family to have a large number of children. 2-Health motives: The high infant and preschool death rates lead to worry of the family of loosing their children; therefore they compensate for these expected losses by having more children; 3-Cultural and religious motives: - Traditions and community believes to have large family since this is considered as a source of power and social status. - Some wives believe that large number of children ensure security and prevent divorce. - Some believes that religion is against family planning.
63. 63. 1- Economic motives: Children would need large expenses to enjoy good education and health. Thus, with a fixed income smaller family will enjoy better living standards. 2- Health motives: - The health of the mother and children are better with spacing of pregnancies. - Large family can have a bad effect on the physical, mental, social and spiritual health of the family.
64. 64. Dimensions of the population problem in Egypt are summarized in: A-Population Growth, B-Population Characteristics, and C-Population Distribution
65. 65. Show Desktop.scf Population Growth .
66. 66.  Improvement in the health conditions in the last few years has lead to a decrease in the death rate and a proportion of the birth rate and thus the rate of natural increase has remained high.  But, due to past experience of high birth rate a large number of the population is entering the fertile age group and therefore the population growth will remain high for years before starting to decline.
67. 67.  Total Dependency ratio 62.3%,  CBR = 30.3/1000, CDR = 4.7/1000. RNI =2.51.  Life expectancy for males=71.4, and for females 74.2years,  infant mortality rate=19.7/1000 live birth,  maternal mortality rate=33/100,000 live births  TFR =3.5 children / woman  Literacy percent = 73.8%
68. 68.  About 95% of population live around the Nile in a very narrow area representing 5% of Egypt land, so population density is very high.  Population problem is the result of inadequate equilibrium between income (resources) increase and population increase.
69. 69.  The solution of this problem: I-long term solution (increasing resources) by investment in industry, increasing land cultivation and productivity, exportation, building new factories, reclaiming desert, female education etc. II-Short term solution is by decreasing birth rate. In other words we empower low fertility motives and try to decrease high motives.
70. 70. C-Morbidity indices:  They are disease occurrence data that are used in disease surveillance.  The most widely used measures of illness in a population are incidence prevalence rates Attack rate Case fatality rate
71. 71.  Number of new cases of illness in a specified time / Population at risk X1000 (or 10000) in the same time and place.  The population at risk can be the entire population in a specified area, or specific group of people such as people of certain age, sex etc.  ITS VALUE:  • It is very important parameter in epidemiology.  • It tells us about new cases and thus we can associate this event of illness with the possible causal factors.  • It can be calculated for both chronic and acute diseases.  • It measures the relative importance of one illness over the other
72. 72.
73. 73. Two types of prevalence measurement: A-Point prevalence: Number of current cases (old & new) of an illness at a point of time / Population examined at same point of time x constant. Point of time is a short period (days, month). B-Period Prevalence: Number of current cases of an illness over a period of time / Population examined at the same period X constant. Period of time is longer (months, years).
74. 74. The prevalence is an indicator of the burden of disease on the population since it reflects the number of cases whether old or new. It measures the relative importance of one illness over the other Can be used for evaluation of health services.
75. 75.  It is an incidence rate estimated in an epidemic (or outbreaks) when observation of population at risk is for short period.  Overall Attack rate: Number of new cases of specific disease reported during epidemic period of time / Total number of persons at risk during the same time X 100
76. 76. Number of deaths of cases from specific illness in specific time Number of cases of the same illness in the same time and place X K Value: It measures the virulence of the agent and the severity of the disease. Therefore is considered as a morbidity measure although it involves deaths.
77. 77. D-Mortality indices or Death indices  They are not effective as the morbidity indices but sometimes they are the only available data. Values or benefits of death indices:  Death rates are important indicator of the health status in a community.  They can indicate the impact of a particular cause on the population.  They can study the relation of a certain cause to the disease occurrence.
78. 78.  Crude Death rate (CDR)  Cause specific death rate  Age specific death rate  Sex specific death rate  Age-sex specific death rate  Infant mortality rate (neonatal – post neonatal)  Perinatal mortality rate  Maternal mortality rate (ratio)  Proportional (relative) mortality rate  Case – fatality rate.
79. 79.  Is the number of deaths in a specific period/ mid year population at the same period and place X 1000.  The crude death rate in Egypt has decreased to reach 4.7 / 1000 population in 2016. This improvement can be attributed to community development, better health services, application of modern techniques, new drugs, health education etc.  Disadvantages: The CDR is not specific rate as it includes all deaths in a population irrespective of its age, sex distribution or cause of death. 1-Crude death rate (CDR):
80. 80. Number of deaths from a specific cause in a specific time/ Mid year population at the same time period X constant The cause specific mortality rate describes the severity of the disease to cause deaths. Cancer has high cause specific MR. 2- Cause Specific Mortality Rate:
81. 81.  Number of deaths in a specified age group and specific time /Population of the same age group and at the same time period X constant  The age specific mortality rates describe the rate of deaths in each age group.  The causes of deaths among age groups are different and therefore by using this rate we can prioritize these causes to be solved. 3-Age specific Mortality Rate ASMR:
82. 82.  Number of deaths in a certain sex in a specific time /Population of the same sex at the same time period X constant  The sex specific mortality rate describes the rate of deaths in each sex.  The causes of deaths among different sex are different and therefore by using this rate we can identify health problems related to sex. 4-Sex specific Mortality Rate ASMR:
83. 83.  Number of deaths of males or females at certain age group at certain area and time / number of males or females of the same age group X 1000 in the same area and time. 5- Age- Sex specific Mortality Rate ASSMR:
84. 84. Maternal Mortality Ratio:  Number of deaths among women due to causes related to pregnancy, labor and puerperium in a specific year & locality /live births in the same year & locality X 100,000  It accounts for the greatest number of deaths among women in reproductive age in devloping countries. (33 deaths /100000 live births 2016) 7- Maternal Mortality Ratio
85. 85. Proportional (relative) mortality Rate:  Number of deaths from a specific cause in a specific time /Total deaths from all causes X constant  It describes the relative importance of a specific disease as a cause of mortality in relation to other causes. 8- Proportional (relative) mortality Rate:
86. 86.  The risk of dying and contracting most diseases are related to age and sex.  So, Crude death rate and overall incidence and prevalence rates depend critically on age-sex composition of any population.  For example, a relatively older population would have a higher crude death rate than a younger population.
87. 87.  In order to compare overall morbidity rates and crude death rate across countries,  to neutralize the difference in age and sex composition by using: and 1- Direct method 2- Indirect method
88. 88.  The choice of method is usually governed by the availability of data and their accuracy.  However, indirect standardization is more commonly employed for mortalities and incidences.  Direct standardization is more commonly employed for prevalence.
89. 89.  In this method we use (a standard population). This is usually one of the following : either one of the study populations or the total of both populations.  Then, the age-sex specific rates from each of the populations under study are applied to the standard population to give age-sex adjusted rates. Death rates
90. 90.  The age –sex specific rates from a standard population are applied to each of the populations of interest to give standardized (morbidity or mortality) ratios which in turn are used to calculate age-sex adjusted rates. Death rates
91. 91. Is Data collection important??? Yes or No. HOW??????  1. Diagnosis of community health problems & assess community needs  2. Helps in the comparison of health status and diseases in different countries and in one country over the years.  3. Evaluation of health services & health programs. Sources of data collection
92. 92. Sources of data collection Primary Sources: (the investigator "s" collects data not present before) It can be either qualitative or quantitative. Secondary Sources: (already present data, routinely collected and reported by government or authorized centers)
93. 93. Sources of data collection 1-Qualitative data: will provide us with insight on personal ideas, opinions, and attitudes. It can be carried out by focus group and in- depth interview. 2-Quantitative data: Survey study. These are field investigations that are carried out to find the frequency of a specific disease in a population. Either we include every member of the population (census) or take sample survey, in which only a selected part of the population is included. The survey can provide more detailed information and also it has the ability to evaluate the data collection methods.
94. 94. Sources of data collection 1-National census 2- Surveillance 3-Records 4-International Classification of diseases (lCD)
95. 95. Sources of data collection 1-National census It provides a wealth of demographic and economic data.
96. 96. Sources of data collection 2- Surveillance It refers to special reporting system (notification) which is set up for a particular important health problem or threatening disease.
97. 97. Sources of data collection 3-Records e.g. birth, death certificates and health care registries as hospital records, school records, data of insured groups, armed forces, absenteeism of workers.
98. 98. Secondary Sources of data collection 3-Records Importance of records: 1 - Birth certificates provide denominators for computation of rates that describe events related to infancy and pregnancy, labor, puerperium. 2- Disease notification and registration provide data for calculation of - Incidence rate, prevalence rate. - Relative fluctuation of disease and its geographic distribution. - Data for planning and evaluation of preventive measures. Drawbacks of records: -Variation in diagnostic criteria and definition of case. -Incomplete & inaccurate data records (as in hospital files). -The number of notified cases is far less than the number occurring. - Records of special subgroups who have special characteristics will limit the generalization of data on the whole community.
99. 99. Sources of data collection 4-International Classification of diseases (lCD) It provides a more standard way to record diseases and health problems. It is used to classify diseases and other health problems in a standard way. It allows the storage and retrieval of diagnostic information for clinical and epidemiological purposes. Provides the basis for the collection of national mortality and morbidity statistics by WHO.
100. 100. Summary Primary Sources: 1-Qualitative: focus group & indepth interview 2-Quantitative: survey Secondary Sources: 1. Census 2. Surveillance 3. Records 4. ICD
101. 101.  In September 2000, building upon a decade of major United Nations conferences and summits, world leaders came together at the United Nations Headquarters in New York to adopt the United Nations Millennium Development Declaration.  The Declaration committed nations to a new global partnership to reduce extreme poverty, and set out a series of eight time-bound targets - with a deadline of 2015 - that have become known as the Millennium Development Goals (MDGs).
102. 102.  Eradicate extreme poverty and hunger.  Achieve universal primary education.  Promote gender equality and empower woman.  Reduce child mortality.  Improve maternal health.  Combat AIDS / Malaria and other diseases.  Ensure environmental sustainability.  Develop a global partnership for development.