5.4 Global mortality trends and differentials

Global mortality trends have changed dramatically over the past century. Life expectancy has increased worldwide due to better living standards, healthcare, and disease control. However, disparities persist between regions and countries, with some areas still experiencing much lower life expectancy.

Mortality differentials are influenced by various factors. Socioeconomic status, environmental conditions, behaviors, healthcare access, and cultural practices all impact mortality rates. Understanding these differentials is crucial for addressing health inequalities and improving population health outcomes globally.

Global Mortality Trends

Measuring Mortality

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• Crude death rate (CDR) represents the number of deaths per 1,000 population in a given year, offering a snapshot of the overall level of mortality in a population
• Age-specific mortality rates quantify the number of deaths per 1,000 population within a specific age group, revealing variations in mortality risk across different life stages
• Life expectancy at birth indicates the average number of years a newborn is expected to live, assuming current age-specific mortality rates remain constant throughout their life, serving as a key indicator of overall population health and longevity

Long-term Changes in Mortality

• Over the past century, global life expectancy has increased significantly due to improvements in living standards (better nutrition and housing), healthcare (vaccinations and medical treatments), and disease control (sanitation and hygiene)
• However, disparities in life expectancy persist across regions and countries, with some areas experiencing much lower life expectancy than others
• The epidemiological transition theory describes the shift from high to low mortality rates as societies develop, characterized by a change in the leading causes of death from infectious diseases (tuberculosis, cholera) to chronic and degenerative diseases (heart disease, cancer)

Mortality Differentials

Socioeconomic and Environmental Factors

• Socioeconomic factors, such as income (poverty vs. affluence), education (literacy and health knowledge), and occupation (manual labor vs. professional roles), influence mortality rates, with populations of higher socioeconomic status generally experiencing lower mortality
• Environmental factors, including access to clean water, sanitation (proper waste disposal), and adequate housing (ventilation and space), impact mortality rates, as poor living conditions can increase exposure to disease and health risks

Behavioral and Healthcare Factors

• Behavioral factors, such as diet (nutrition and food security), physical activity (sedentary vs. active lifestyles), smoking (tobacco use), and alcohol consumption (excessive drinking), affect mortality risk, with unhealthy behaviors being associated with higher mortality rates
• Access to healthcare services and the quality of care vary across regions and populations, contributing to mortality differentials, as limited access to preventive care (immunizations), medical treatment (medications), and essential medicines can lead to higher mortality rates

Demographic and Cultural Factors

• Demographic factors, such as age structure (proportion of elderly) and sex composition (ratio of males to females), influence mortality patterns, with populations having a higher proportion of older individuals or a skewed sex ratio potentially experiencing different mortality rates
• Cultural factors, including religious beliefs (faith-based practices), traditional practices (home births), and social norms (gender roles), can impact health-seeking behavior and mortality outcomes, such as cultural preferences for male children leading to neglect and higher mortality rates among female infants in some societies

Impact of Health Interventions

Disease Prevention and Control

• Immunization programs have significantly reduced mortality from vaccine-preventable diseases (measles, polio), particularly among children, with widespread vaccination coverage leading to the eradication of smallpox and substantial declines in other infectious diseases
• Disease-specific interventions, such as antiretroviral therapy for HIV/AIDS, directly observed treatment for tuberculosis (DOTS), and insecticide-treated bed nets for malaria, have contributed to declines in mortality from these major infectious diseases

Maternal and Child Health

• Maternal and child health interventions, such as antenatal care (prenatal check-ups), skilled birth attendance (trained midwives), and postnatal care (follow-up visits), have contributed to reductions in maternal and infant mortality rates, with access to essential obstetric services and interventions to prevent and manage complications during pregnancy and childbirth being crucial
• Public health campaigns and policies targeting specific health issues, such as tobacco control (smoking bans), road safety (seat belt laws), and obesity prevention (nutrition education), can influence mortality trends, with effective implementation and enforcement of these measures reducing deaths from preventable causes

Health Systems and Financing

• Health system strengthening initiatives, including investments in infrastructure (clinics and hospitals), workforce development (training healthcare workers), and supply chain management (ensuring availability of medicines), can improve the capacity to deliver essential health services and reduce mortality rates
• Health financing mechanisms, such as universal health coverage (affordable access to healthcare) and social health insurance (risk pooling), can reduce financial barriers to accessing healthcare and improve health outcomes, potentially lowering mortality rates

Mortality and Demography

Interactions with Fertility and Migration

• Mortality and fertility are closely interrelated, with high infant and child mortality rates potentially leading to higher fertility rates as parents seek to replace lost children or ensure the survival of a desired number of offspring, while declining mortality rates can contribute to fertility declines as parents gain confidence in the survival of their children
• Migration can impact mortality rates in both origin and destination areas, with selective migration of healthier individuals potentially leading to lower mortality rates in destination areas (brain drain), while the reverse may occur in origin areas (left behind population)

Population Dynamics and Transitions

• Mortality patterns influence population age structure, with high mortality rates among infants and children resulting in a younger age structure (broad-based population pyramid), while declining mortality and increasing life expectancy lead to population aging (inverted population pyramid)
• Urbanization and mortality have a complex relationship, as urban areas often have better access to healthcare and sanitation (municipal services) but can also be associated with increased exposure to pollution (air and noise), occupational hazards (industrial accidents), and lifestyle-related health risks (sedentary behavior)
• Mortality crises, such as famines (food shortages), epidemics (disease outbreaks), and conflicts (wars and civil unrest), can have significant short-term and long-term effects on population dynamics, leading to sudden spikes in mortality rates and altering the demographic composition of affected populations
• The demographic transition theory links changes in mortality and fertility rates to socioeconomic development, with societies progressing through the transition experiencing a decline in mortality rates first, followed by fertility declines, leading to changes in population growth rates and age structure