The Health and Mortality Transition

1
Chapter 5

• The Health and Mortality Transition

2
Chapter Outline

• Defining the Health and Mortality Transition
• Life Span And Longevity
• Disease and Death Over the Life Cycle
• Causes Of Poor Health and Death
• Measuring Mortality
• Health and Mortality Inequalities

3
Defining the Health and Mortality Transition

• Health and death are two sides of morbidity and
  mortality.
• Morbidity refers to the prevalence of disease in
  a population.
• Mortality refers to the pattern of death.

4
Defining the Health and Mortality Transition

• For virtually all of human history, early death
  was commonplace.
• As a result, the variability by age in mortality
  is compressed, leading to an increased
  rectangularization of mortality.
• This means most people survive to advanced ages
  and die pretty quickly.
• The changes brought about as people survive to
  ever older ages are important contributions to
  the demographic transition.

5
Health and Mortality Changes Over Time

• For most of history, life expectancy fluctuated
  between 20 and 30 years.
• About 2/3 of babies survived to their first
  birthday, and about 1/2 were still alive at age
  five.
• At the other end of the age continuum, around 10
  of people made it to age 65 in a premodern
  society.

6
The Middle Ages

• The plague, or Black Death, hit Europe in the
  fourteenth century, having spread west from Asia.
• It is estimated that 1/3 of the population of
  Europe may have perished from the disease between
  1346 and 1350.

7
The Roman Era

• Life expectancy in the Roman era is estimated to
  have been 22 years.
• People who reached adulthood were not too likely
  to reach a very advanced age.

8
The Columbian Exchange

• Refers to the diseases that Columbus and other
  European explorers took to the Americas.
• Their immunity to the diseases they brought,
  compared with the devastation the diseases
  wrought on indigenous populations, is one
  explanation for the relative ease with which
  Spain dominated Latin America after arriving
  there around 1500.

9
Industrial Revolution to the Twentieth Century

• By the early 19th century, after the plague had
  receded and as increasing income improved
  nutrition, housing, and sanitation, life
  expectancy in Europe and the U.S. was
  approximately 40 years.
• There were as many deaths to children under 5 as
  there were at 65 and over.
• Infectious diseases were still the dominant
  reasons for death, but their ability to kill was
  diminishing.

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The Meaning of Improvements in Life Expectancy
11
The Meaning of Improvements in Life Expectancy
12
The Meaning of Improvements in Life Expectancy
13
The Meaning of Improvements in Life Expectancy
14
Life Expectancy Has Improved in the U.S., Canada,
and Mexico
15
Changes in Life Expectancy Since the End of World
War II (Females)
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Changes in Life Expectancy Since the End of World
War II (Females)
17
Changes in Life Expectancy Since the End of World
War II (Males)
18
Changes in Life Expectancy Since the End of World
War II (Males)
19
Postponing Death by Preventing and Curing Disease

• There are two ways to postpone death to the
  oldest possible ages
• Prevent diseases from occurring or from spreading
  when they do occur.
• Curing people of disease when they are sick.

20
The Nutrition Transition

• A marked worldwide shift toward a diet high in
  fat and processed foods and low in fiber,
  accompanied by lower levels of physical exercise,
  leading to corresponding increases in
  degenerative diseases.

21
Life Span and Longevity

• Life span is the oldest age to which human beings
  can survive.
• Longevity is the ability to resist death.
• Life span is almost entirely a biological
  phenomenon.
• Longevity has biological and social components.
• Populations with high mortality are those with
  high morbidity.

22
Age Differentials in Mortality

• Humans are like most other animals with respect
  to the general pattern of death by agethe very
  young and the old are most vulnerable, whereas
  young adults are least likely to die.
• After the initial year of life, there is a period
  of time, usually lasting at least until middle
  age, when risks of death are relatively low.
• Beyond middle age, mortality increases, although
  at a decelerating rate.

23
The Very Young and the Old Have the Highest Death
Rates
24
Variations in Infant Mortality Around the World
25
The Rectangularization of Mortality in the United
States
26
Causes of Poor Health and Death

• The World Health Organization puts deaths into
  one of three major categories
• communicable, maternal, perinatal, and
  nutritional conditions
• Noncommunicable diseases
• injuries

27
Urban and Rural Differentials in Mortality

• Early differences in urban and rural mortality
  were due less to favorable conditions in the
  countryside than to unfavorable conditions in the
  cities.
• Over time, medical advances and environmental
  improvements have benefited the urban population
  more than the rural, leading to the current
  situation of better mortality conditions in urban
  areas.

28
Occupational Differentials in Mortality

• Among white American men aged 25 to 64 when they
  died in 1960, mortality rates for laborers were
  19 above average, while those for professional
  men were 20 below average.
• Researchers followed a group of 12,000 civil
  servants in London who were first interviewed in
  196769 when they were 40 to 64.
• They were tracked for the next 10 years, and it
  was clear that after adjusting for age and sex,
  the higher the pay grade, the lower the death
  rate.

29
Income, Education and Mortality

• Kitagawa and Hausers data for 1960 showed y that
  as income went up, mortality went down.
• Death data for the United States in 2003 show
  that age-adjusted death rates for people with at
  least some college were less than one-third the
  level of people with less than a high-school
  education.

30
Race, Ethnicity and Mortality

• In societies with more than one racial or ethnic
  group, one group will tend to dominate, leading
  to disadvantages for the subordinate groups that
  can result in lower life expectancies.
• In the U.S., African-Americans and Native
  Americans have historically experienced
  higher-than-average death rates.
• United States data for 2003 show that at every
  age up to 70, African-American mortality rates
  are double the rates for the white population.

31
Marital Status

• It has long been observed that married people
  tend to live longer than unmarried people.
• One explanation is that marriage is selective of
  healthy people that is, people who are
  physically handicapped or in ill health may have
  both a lower chance of marrying and a higher risk
  of death.
• Another explanation is that marriage is good for
  your health.

32
Premodern Mortality

• For most of human history, life expectancy was 20
  to 30 years.
• About 2/3 of babies survived to their first
  birthday, and about 1/2 were still alive at age
  five.
• Around 10 of people made it to age 65.