IJE Advance Access originally published online on June 5, 2007
International Journal of Epidemiology 2007 36(3):484-490; doi:10.1093/ije/dym075
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2007; all rights reserved.
The changing relation between mortality and level of economic development
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The influence of economic conditions on mortality has been recognized at least since biblical times. Empiricism of the most casual sort was sufficient to establish the link between food supply and mortality. Other components of living standards, such as shelter and living space, awaited a revolution in scientific method before their influence was finally acknowledged. But recent years have witnessed a movement away from economic determinism in mortality analysis. It is widely believed that mortality has become increasingly dissociated from economic level because of a diffusion of medical and health technologies, facilities and personnel that occurred, in large part, independently of economic level, yet this position has its critics who have gained a sympathetic audience.1–4 This article utilizes readily available evidence in a new but obvious way to estimate the relative contribution of economic factors to increases in life expectancy during the 20th century. The evidence consists of cross-sectional relationships
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Types of relationships |
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Level of income influences level of mortality at a moment in time
Level of income influences rate of change in mortality
Rate of change of income influences rate of change of mortality
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The relations re-examined |
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1. The relationship between life expectancy and national income per head has shifted upwards during the 20th century
2. Factors exogenous to a country's current level of income probably account for 75–90% of the growth in life expectancy for the world as a whole between the 1930s and the 1960s. Income growth per se accounts for only 10–25%
3. Mortality has not become progressively dissociated from standards of living at a moment in time
3a. Some of the observed scatter in cross-sectional relations is almost certainly caused by differences in national income distributions
4. Factors exogenous to a nation's level of income per head have had a major effect on mortality trends in more developed as well as in less developed countries
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