Theory of Mortality Decline

By:

Laxman singh Kunwar, PhD

 Theory on Mortality Decline

• Demographers have for a long time adopted an

empirical approach to the study of the levels and
trends of mortality, fertility, and population size.
• They depend for their analyses on data, usually
collected until recent times by government and
often for other purposes. Modern demography
had its origins in Britain in the second half of the
seventeenth century.
• The major focus of demographers has usually
been on mortality, although fertility studies
predominated in the 1960s and 1970s.
 Contd..
• Mortality decline in the West only became
certain in the late nineteenth century. Until the
1960s the fastest mortality declines were for the
young, but an unheralded mortality decline
among the old thereafter became important.
• The world, especially in economically advanced
countries, is faced with an increasingly high
proportion of old people, explained largely, not
by mortality decline, but by fertility decline.
 Contd..
• Explanations for the mortality transition place different
emphases on the role of modern medicine, better nutrition,
and behavioral and social change, particularly rising levels of
education.
• Even among the old, at least until 85 years of age, there are
wide differentials in mortality by educational level.
• Analysts have divided the mortality transition into stages: (1)
high, pre transitional mortality, (2) early transitional mortality
with the decline explained by the conquest of infectious
disease, and (3) late transitional mortality largely attributable
to degenerative disease. Some have now added stage (4), the
reduction or delay in death from degenerative causes.
 Mortality and Population Dynamics
• Proposition one: The theory of
epidemiological transition begins with the
major premise that mortality is a fundamental
factor in population growth
Shift in mortality and disease pattern

Proposition two:
Three major successive stage of epidemiological transition
• The age of pestilence and famine (mortality high and
fluctuating, sustained population growth, average life
expectancy 20-40 yrs
• The age of receding mortality(mortality decline progressively,
epidemic peak disappear, population growth sustained, life
expectancy 30 to about 50 yrs
• The age of degenerative and man-made disease (mortality
continued decline and approaches stability at a relatively low
level, fertility becomes crucial factor in population growth)
 Relative Risks of Mortality by Age and sex..
Proposition Three:
• During epidemiologic transition the most propound changes in
health and diseases patterns obtain among children and young
women.
Proposition Four: Interacting transition variables
• The shift in health and disease pattern that characterized
epidemiological transition are closely associated with
demographic and socioeconomic transition constitutes the
modernization complex
Proposition Five: Basic models of demographic transition
• Peculiar variation in the pattern, place, the determinants and
consequences of population change differentiate three basic
models of epidemiological transition: the classical, accelerated and
contemporary.
 Epidemiological Transition
• Attempts have been made to effect the convergence of
demographic and epidemiological approaches to the analysis of
mortality, and they have been more successful in the case of
medical demographic than in social demographic approaches
• Abdel Omran’s 1971 theory of epidemiological transition is an
attempt to account for the extraordinary advances in health
care made in industrialized countries since the 18th century.
• According to Omran, all societies experience three "ages" in the
process of modernization: the "age of pestilence and famine",
during which mortality is high and fluctuating, with an average
life expectancy under 30 years;
 Contd..
• the "age of receding pandemics", during with
life expectancy rises considerably, from under
30 to over 50; and
• the "age of degenerative and man-made
diseases", during which the pace of the
mortality decrease slackens, while the
disappearance of infectious diseases increases
the visibility of degenerative diseases, while
man-made diseases become more and more
frequent.
 Contd..
• Epidemiological transition focus on the
complex change in the pattern of health and
disease and on interaction between these
pattern and their demographic, economic and
social determinants and consequences
• An epidemiological transition has paralleled
the demographic and technologic transition in
new developed countries of the world and still
underway in less developed society
 Contd..
• At the time Abdel Omran was developing his theory of
epidemiologic transition, the most competent specialists,
along with United Nations experts, saw life expectancies
as generally converging towards a maximum age, the
most advanced countries seeming very close to it.
• According to the United Nations World Population
Prospects, the point of convergence was 75 years (United
Nations, 1975).. And as things now stand in the most
advanced countries,
• the increase in life expectancy has slowed down since
the 1960s and in some countries has even halted, in
particular as concerns men.
 Contd..
• The "cardiovascular revolution" of the 1970s launched a new
period of progress. However, Jay Olshansky and Brian Ault
(1986), followed by Richard Rogers and Robert Hackenberg
(1987), without criticizing the basic premises of the theory of
epidemiologic transition, introduced the idea of a "fourth
stage"4 during which the maximum point of convergence of life
expectancies would seem to increase thanks to achievements in
the treatment of cardiovascular diseases.
• Jay Olshansky et al. (1990) set this new maximum at 85 years,
the same as that chosen by the United Nations at the end of the
1980s for all countries (United Nations, 1989).
• Today, the 85-year threshold is strongly criticized by many
authors who believe that such a limit cannot be determined
(Barbi et al, 1999; Vaupel, 2001; Carey and Judge, 2001).
Demographic transition
 Epidemiological transition
• In demography and medical geography, epidemiological
transition is a phase of development witnessed by a sudden
and stark increase in population growth rates brought about
by medical innovation in disease or sickness therapy and
treatment, followed by a re-leveling of population growth
from subsequent declines in fertility rates.
• "Epidemiological transition" accounts for the replacement
of infectious diseases by chronic diseases over time due to
expanded public health and sanitation. This theory was
originally posited by Abdel Omran in 1971
 Contd..
• Omran divided the epidemiological transition of mortality into three
phases, in the last of which chronic diseases replace infection as the
primary cause of death.
These phases are:
• The Age of Pestilence and Famine: Where mortality is high and
fluctuating, precluding sustained population growth, with low and
variable life expectancy, vacillating between 20 and 40 years.
• The Age of Receding Pandemics: Where mortality progressively
declines, with the rate of decline accelerating as epidemic peaks
decrease in frequency. Average life expectancy increases steadily from
about 30 to 50 years. Population growth is sustained and begins to be
exponential.
• The Age of Degenerative and Man-Made Diseases: Mortality continues
to decline and eventually approaches stability at a relatively low level.
 Contd..
• The epidemiological transition occurs as a country
undergoes the process of modernization from
developing nation to developed nation status.
• The developments of modern healthcare, and
medicine like antibiotics, drastically reduces infant
mortality rates and extends average life
expectancy which, coupled with subsequent
declines in fertility rates, reflects a transition to
chronic and degenerative diseases as more
important causes of death
 Contd..

• In this last year of the twentieth century, with

so many countries nearing the end of their
fertility transitions, it might be thought a bit
late to advance a new agenda on mortality
decline.
• Nevertheless, a new agenda is warranted, and
its priority items might be as usefully pursued
in countries with moderate levels of mortality
as in those with high mortality
 Contd..
• individual perceptions of health levels and trends,
including mortality risks, with the concept of social
learning being prominent;
• the overlap of modern and traditional health care
systems and the associated beliefs, with an
emphasis on the perceived efficacy of modern
modes of prevention and treatment;
• the role played by perceived mortality risks and
health in affecting parental investments in
schooling, with attention to adult as well as to
child mortality and health.
 Contd..
• Information can be gathered from interactions
with family, discussions in peer groups and
other social networks, and conversations with
the better-educated; it can be distilled from
• media messages and from the modern health
sector.
• All these can be regarded as avenues for social
learning and diffusion
 Contd..

• Learning from family

• Learning through social networks
• Personal agency and modern health care
• Extending the modern system’s reach
• Social and political agency
• Investment in children