Abstract the Determinants of Mortality
Mortality rates have fallen dramatically over time, starting in a few countries in the 18th century, and continuing to fall today. In just the past century, life expectancy has increased by over 30 years. At the same time, mortality rates remain much higher in poor countries, with a difference in life expectancy between rich and poor countries of also about 30 years. This difference persists despite the remarkable progress in health improvement in the last half century, at least until the HIV/AIDS pandemic. In the closing decades of the nineteenth century and into the twentieth, the second phase occurred, in which public health mattered more—first negatively, because of high mortality in cities, then positively in the delivery of clean water, removal of wastes, and advice about personal health practices. The third phase, dating from the 1930s on, has been the era of big medicine, starting with vaccination and antibiotics, and moving on to the expensive and intensive personal interventions that characterize the medical system today Is there a universal theory of mortality that can explain improvements over time, differences across countries, and differences across groups? The authors argue that "knowledge, science, and technology are the keys to any coherent explanation," perhaps controversially downplaying the role of income. As for the future, they predict that an acceleration in the production of new knowledge and treatments is likely to increase inequality in health outcomes in the short run, but the silver lining is that "help is on the way, not only for those who receive it first, but eventually for everyone."