Public HealthMortality trends and setbacks: global convergence or divergence?
Section snippets
Trends in life expectancy
The figure shows three groupings of national life expectancy trends over the past half-century, with data from the UN World Population Prospects, 2002.22 The three groupings are those suggested by Caselli and colleagues,23 and refer to national populations that have undergone, respectively, rapid gains in life expectancy; slower, perhaps plateauing gains; and frank reversals. The countries shown are representative of each of those three contrasting trends. Chile, Mexico and Tunisia have
Differences within countries
The above analysis has examined inter-country differences. Increasing within-population mortality differentials have also emerged in many developed and developing countries. A central target of WHO's Health for All strategy for Europe, from 1985, was to reduce differences in health status within countries by at least 25% by improving the health of disadvantaged groups. However, socioeconomic gradients in mortality have increased in most developed countries that provide data—at least in a
Technological solutions?
Technological progress will not necessarily narrow these gaps. Such progress has brought great benefits, but has also brought various unintended consequences. For example, the between country gap in life expectancy caused by unequal access to health-care advances has widened. The discovery of insulin in 1921 transformed type 1 diabetes from a rapidly fatal childhood disease to a survivable disorder—but only for those with access to treatment. Other new treatments have meant that more people die
Transient aberrations or continuing divergence?
Are these divergences in population health mere transient aberrations? Or might a worldwide convergence of health indices be less achievable than previously thought? Part of the answer might lie in the fact that, at global and regional scales, major changes are occurring to social and environmental living conditions. These unprecedented global changes will both enhance and impair population health. For example, the global spread of mass schooling, in combination with radios and television,
Conclusion
Globally, life expectancy has been on a long uptrend. However, the emerging picture of variable mortality trends and regional setbacks indicates that future health gains are not guaranteed by any general deterministic process of convergence. Rather, there is an increased heterogeneity between countries, here summarised as those achieving rapid gains, those achieving slower or plateauing gains, and those having frank reversals.
From these varied population health trends, we can understand better
References (39)
- et al.
Changes in life expectancy in Russia in the 1990s
Lancet
(2001) HIV and AIDS, poverty, and causation
Lancet
(2000)- et al.
Equity and health sector reforms: can low-income countries escape the medical poverty trap?
Lancet
(2001) - et al.
Huge variation in Russian mortality rates 1984–1994. Artefact or alcohol?
Lancet
(1997) - et al.
Applying an equity lens to child health and mortality: more of the same is not enough
Lancet
(2003) - et al.
A universal pattern of mortality decline in the G7 countries
Nature
(2000) On the scale of global demographic convergence 1950–2000
Popul Dev Rev
(2001)- et al.
The epidemiological transition
Millbank Mem Fund Q
(1971) Mortality patterns in national populations
(1976)