AP Human Geography · Unit 2 · Health
Five stages of disease change, three scored FRQs with rubrics, quick MCQs, and exam traps—built for Unit 2 population review.
Review first: Read the DTM Overview for birth and death rates, then return here for causes of death.
Use this table when a stimulus names disease types, public health policy, or mortality trends—not birth rates alone.
| Stage | Dominant causes of death | Health focus | Example |
|---|---|---|---|
| 1 — Pestilence & famine | Infectious disease, malnutrition | Basic survival | Pre-modern Europe |
| 2 — Receding pandemics | Infectious; rates fall | Vaccines, sanitation | US/UK early 1900s |
| 3 — Degenerative | Heart disease, cancer | Lifestyle, screening | Mid-late 1900s MDCs |
| 4 — Delayed degenerative | Later-onset chronic disease | Geriatrics, prevention | Japan, Western Europe |
| 5 — Re-emergence? | Resistance, new epidemics | Global surveillance | COVID-19 discussions |
Deaths cluster around infectious disease, poor sanitation, and food shortages. Life expectancy stays low because epidemics and famine recur.
AP move: Cite pre-industrial settings—not modern countries with hospitals and vaccination programs.
Public health, clean water, vaccines, and better nutrition cut epidemic deaths before lifestyle diseases dominate. This often aligns with DTM Stage 2 when crude death rates fall.
Examples: Cholera decline after piped water in industrial cities; smallpox vaccination campaigns.
People live long enough for chronic illness to become the leading killer. Smoking, diet, and occupational hazards add human-made risk factors.
Examples: Mid-twentieth-century United States and Western Europe as cardiovascular disease rose with urban diets.
Medical treatment and prevention push chronic disease later in life. Aging populations need geriatric care, screening, and long-term management.
Examples: Japan and much of Western Europe today—high life expectancy with top-heavy age structures.
Some scholars add Stage 5 when antibiotic resistance, global travel, or novel pathogens revive infectious mortality concerns alongside chronic disease burdens.
Examples: COVID-19 mortality spikes; drug-resistant tuberculosis in crowded cities.
| Feature | DTM | ETM |
|---|---|---|
| Primary focus | Birth & death rates | Causes of death |
| Typical units | CBR, CDR, NI | Disease categories |
| Stage 2 signal | Falling CDR | Receding pandemics |
| Policy link | Fertility programs | Public health systems |
Each prompt comes from real search and exam themes—Omran’s model, DTM comparisons, policy, and limitations. Draft your answer first, then open the rubric and sample.
As development advances, the leading killers move from infectious disease and famine toward chronic conditions such as heart disease and diabetes—exactly what the ETM describes. Geographers rely on the model because it answers which health systems a country needs: sanitation and vaccines in early stages, then screening and long-term care when people live long enough for chronic illness to appear. Pairing ETM with the DTM matters because death rates can fall while birth rates stay high, so population growth and disease patterns do not always change at the same pace.
Draft your answer before revealing the rubric.
Stage 1 societies lose large shares of their population to infectious disease and famine; Stage 2 begins when epidemic deaths drop while many births continue. Piped water and childhood vaccination campaigns are classic drivers, because they target the pathogens that still kill infants and working-age adults. Thailand in the late twentieth century shows the split: health officials were fighting infectious mortality (ETM Stage 2) even as family-planning programs were pulling fertility down toward DTM Stage 3—same country, different clocks on each model.
Draft your answer before revealing the rubric.
Many governments in South Asia and sub-Saharan Africa achieved steep drops in infectious mortality in a few decades—far faster than nineteenth-century Europe—so stage labels from Western timelines fit poorly. Stage 5 reminds students that even Japan or Germany can face sudden COVID-19 surges or drug-resistant tuberculosis despite low fertility and advanced hospitals. The ETM is still useful for naming dominant causes of death, but exam answers should avoid treating every country as marching through identical centuries-long steps.
Draft your answer before revealing the rubric.
ETM-focused practice. For more items, use the DTM practice quiz.
Q1. Which causes of death dominate ETM Stage 1?
EasyAP tip: ETM asks what kills people, not CBR/CDR levels.
Q2. Improved sanitation and vaccines most directly signal:
MediumAP tip: Pair with DTM Stage 2 when death rates fall first.
Q3. Heart disease as the leading cause of death suggests:
MediumAP tip: Longer life expectancy makes chronic disease visible.
Mistake: ETM is about birth rates
Fix: ETM tracks causes of death and disease patterns.
Mistake: Same stage on DTM and ETM
Fix: Health can improve while fertility stays high.
Mistake: Ignoring re-emerging disease
Fix: Globalization can spread new or resistant pathogens.
Mistake: Label only, no evidence
Fix: Name disease types or health policies that support the stage.
Identify ETM stage from disease data → explain why mortality shifted → link one public health policy → connect to DTM only if the prompt asks about population growth.
A model describing how dominant causes of death shift from infectious disease to chronic conditions as countries develop.
Abdel Omran summarized twentieth-century mortality shifts in industrialized countries.
DTM tracks birth and death rates; ETM tracks disease types and health infrastructure.
Receding pandemics as public health, vaccines, and sanitation reduce infectious deaths.
Degenerative and human-made diseases such as heart disease and some cancers.
Yes—health can improve while fertility remains high, producing different stage numbers on each model.
Rising expectancy reflects fewer infectious deaths; study life expectancy alongside ETM stages.
Start with the DTM overview and practice MCQs.