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Mortality: Global patterns and trends

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Although global mortality variations have declined significantly in the last century, considerable inequalities remain, reflecting at least partly the wealth gap between MEDCs (more economically developed countries) and LEDCs (less economically developed countries). However, mortality differences exist not only on the global scale but also within continents, countries and national regions.

‘This year, almost eleven million children under five years of age will die from causes that are largely preventable. Among them are four million babies who will not survive the first month of life. On top of that 3.3 million babies will be stillborn. At the same time, about half a million women will die in pregnancy, childbirth or soon after.’

The World Health Report 2005

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small globe iconThe global decline in mortality

The decline in levels of mortality and the increase in life expectancy has been the most tangible reward of development. On a global scale, 75 per cent of the total improvement in longevity has been achieved in the twentieth century and the early years of the twenty-first century. In 1900, the world average for life expectancy is estimated to have been about 30 years, but by 1950–55 it had risen to 46 years. By 1980–85 it had reached a fraction under 60 years and is presently, according to the 2005 World Population Data Sheet (Population Reference Bureau), 67 years. However, the global average masks significant differences by world region.

The twentieth century’s fall in mortality was particularly marked from after the Second World War, which had provided a tremendous impetus for research into tropical diseases. It is thus not surprising that the pace of mortality reduction was especially rapid in the 1950s and 1960s. Mortality reduction slowed in the 1970s, as large-scale programmes for the eradication of diseases reached their limits. From then on, the most obvious aspects of poverty – poor nutrition and lack of clean water and sanitation – have slowed improvement in much of the developing world.

small globe iconHow is mortality measured?

The crude death rate, the most common measure of mortality, is also the most limited in scope. The term ‘crude’ in terms of statistical data means that the data (here, the crude death rate) is very generalised because it has not been analysed in detail. The crude death rate looks at the mortality of the whole population, so it is heavily influenced by age structure. For example, Brazil (7 per 1000) has a lower crude death rate than Britain (10 per 1000) because it has a much younger population. In Brazil, 29 per cent of the population are under 15 years of age, with only 6 per cent at 65 years and over. For Britain the respective figures are 18 per cent and 16 per cent. However, as most people would expect, life expectancy is considerably higher in Britain at 78 years compared with 71 years in Brazil. This is because living standards are much better in Britain, mainly as a result of significantly higher incomes.

Therefore the most accurate measures of mortality are:

  • life expectancy
  • age-specific mortality rates.

In terms of the latter, the infant mortality rate, with a one-year age band, is the most frequently used, followed by the child mortality rate life expectancy with a five-year age band. The infant mortality rate is often seen as the best measure of a country’s socio-economic progress because investing in health, water supply and other basic aspects of development can significantly reduce infant mortality. More detailed analyses of mortality also consider the perinatal and neonatal mortality rates.

Mortality rates are available at every year of age in many countries, particularly the more affluent ones where records are extremely accurate because of the legal requirement to register all deaths. Age-specific mortality data is used by the life insurance industry to set premiums. All other things being equal, insurance premiums increase with age.

small globe iconThe crude death rate: global variations

From what has already been said about the influence of age structure, it is not surprising that the lowest crude death rates are in the developing world (Figure 1). For each country listed in Figure 1 the percentage of population under 15 and 65-plus also illustrates the impact of age structure on the crude death rate.

The 2005 Population Data Sheet recorded a crude death rate of only 1/1000 for the United Arab Emirates and 2/1000 for Kuwait. Bahrain, Qatar, Saudi Arabia, Andorra and Brunei have a rate of 3/1000. Apart from Andorra, all these countries have at least 25 per cent of their populations under the age of 15. And again, apart from Andorra, all of these countries have no more than 3 per cent of their populations aged 65 and over.

However, some of the highest crude death rates are also in the developing world, concentrated in the poverty belt of sub-Saharan Africa (Figure 2), with Botswana and Lesotho recording the highest figure of 28 per 1000. Even the impact of very high fertility cannot mask high age-specific mortality, resulting in an average life expectancy in Africa as a whole of 52 years, well below any other world region.

Mortality rates can, of course, also vary significantly within individual countries. This holds true for both developed and developing countries. Regions benefiting from a higher level of medical infrastructure and a better quality of life will generally control mortality to a greater extent than worse-off regions.

Figure 3: Rural Morocco, where health facilities are much less advanced than in the main urban areas.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Figure 1 . Lowest crude death rates.
Figure 1.
Lowest crude death rates.
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Figure 2. Highest crude death rates.
Figure 2.
Highest crude
death rates.
Click here to enlarge.
 
 
 

 
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