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The Changing Relation Between Mortality and Level of Economic Development Author(S): Samuel H Population Investigation Committee The Changing Relation between Mortality and Level of Economic Development Author(s): Samuel H. Preston Reviewed work(s): Source: Population Studies, Vol. 29, No. 2 (Jul., 1975), pp. 231-248 Published by: Population Investigation Committee Stable URL: http://www.jstor.org/stable/2173509 . Accessed: 08/02/2012 11:55 Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]. Population Investigation Committee is collaborating with JSTOR to digitize, preserve and extend access to Population Studies. http://www.jstor.org The ChangingRelation between Mortality and Levelof Economic Development SAMUEL H. PRESTON* The influenceof economicconditions on mortalityhas been recognizedat least since biblical times.Empiricism of the mostcasual sortwas sufficientto establishthe link between food supply and mortality.Other components of livingstandards, such as shelterand livingspace, awaiteda revolutionin scientificmethod before their influence was finallyacknowledged. But recentyears have witnesseda movementaway fromeconomic determinism in mortalityanalysis. It is widely believed that mortalityhas become increasinglydissociated from economic level because of a diffusionof medicaland healthtechnologies, facilities and personnelthat occurred, in largepart, independentlyof economiclevel, yet this position has its criticswho have gained a sympathetic audience!1 This paper utilizesreadily available evidencein a new but obvious way to estimate the relativecontribution of economicfactors to increasesin lifeexpectancy during the twentieth century.The evidenceconsists of cross-sectionalrelationships between national life expectancies and nationalincome per head evaluatedduring three different decades of thetwentieth century. Theserelationships are furtherused to assessthe realism of certain economic-demographic models and to re-examinewhat have becomeclassical distinctions regarding sources of mortalitydeclines in Westernand non-Westernareas. There are severalreasons for focusingon nationalincome ratherthan on anothersocio- economicvariable. First, national income is probablythe best single indicator of living standards in a country,since it comprisesthe value of all finalproducts (goods and services)produced in a certainperiod. A widerange of these products can be expectedto influencemortality, and expendi- tureson all of themare represented,with varying weights, in nationalincome. It is theindicator mostcomprehensive of thesemultiple factors. Secondly, as theleading index of levelof economic development,income per head is the focus of growthmodels fromwhich policy measures are derived.Several of these models incorporate a relationshipbetween mortality and levelof economic development.For example,Leibenstein and Nelson arguethat a smallgain in incomeper head in low-incomecountries will tendto producea declinein mortalityand hencea morerapid rateof populationgrowth that will push the population back to itsinitial level of income.2Partly on this basis theyargue for the necessityof a 'big push' in economicdevelopment in orderto project theeconomy past thepoint where increments in incomecan be dissipatedin thisfashion. Hagen3 and Demeny,4on theother hand, attack this type of 'big push' theoryon thegrounds that mort- alityhas not been responsiveto incomebut ratherto publichealth factors. Which view prevails, obviouslyshould have a decidedimpact on thepolicies pursued. Indeed, Taylor and Hall assert5 * The authorwould like to thankAvery Guest and James McCann for very useful comments on an earlierdraft and JohnMcDonald and JamesWeed for comments, and computationalassistance. This research was supported by NationalScience Foundation grant 33864. 1 HaraldFrederiksen, 'Determinants and Consequencesof MortalityTrends in Ceylon',Public Health Reports, 76 (August1961), pp. 659-663;'Determinants and Consequencesof Mortalityand FertilityTrends', Public Health Reports,81 (August1966), pp. 715-727; 'DynamicEquilibrium of Economicand DemographicTransition', Economic Developmentand CulturalChange, 14 (April 1966), pp. 316-322; David M. Heer, Readingson Population. Prentice-Hall,Englewood Cliffs, N.J., 1968. 2 Harvey Leibenstein,A Theoryof Economic-DemographicDevelopment. Princeton University Press, Princeton, 1954.Richard R. Nelson,'A Theoryof the Low LevelEquilibrium Trap in UnderdevelopedEconomies', American Economic Review,46 (December 1956), pp. 894-908. 3 EverettE. Hagen,On theTheory of Social Change.Dorsey Press, Homewood, Illinois, 1962. 4 Paul Demeny,'Investment Allocation and PopulationGrowth', Demography, 2 (1965), pp. 203-232. Carl E. Taylorand Marie-FranqoiseHall, 'Health,Population, and EconomicDevelopment', Science, 157 (3789) (1967),pp. 651-657. 23I PopulationStudies 29, 2. Printedin Great Britain 232 SAMUEL H. PRESTON that,because of a fearthat public healthprogrammes would be reducedin scope because they werebeing blamed for large increases in ratesof populationgrowth during the post-war period, internationalhealth specialists undertook to discredittheir own role in mortalitydecline and to emphasizethat of economicdevelopment. Models attemptingto simulatethe future course of demographicand economicdevelopment must also address themselvesto the question of the responsivenessof mortalityto economic change.The InternationalLabour Office,' in its simulation model of world employment/population relationships,plans to incorporatean assumptionthat life expectancy increases gradually with averagehousehold incomes. The Limits to Growthalready includes a similarfeature, although the parametervalues appear to have been chosenin a somewhatarbitrary fashion.7 TYPES OF RELATIONSHIPS National income per head in constantdollars is an index of the total value of finalproducts producedper inhabitantduring a definedperiod, exclusive of goods whichmerely replace losses fromdepreciation of capitalequipment. There is no reasonto expecta directinfluence of national incomeper head on mortality;it measuressimply the rate of entryof newgoods and servicesinto the householdand businesssectors. Its influenceis indirect;a higherincome implies and facili- tates,though it does not necessarilyentail, larger real consumptionof itemsaffecting health, such as food, housing,medical and public healthservices, education, leisure, health-related research and, on thenegative side, automobiles,cigarettes, animal fats and physicalinertia. Levels of mortalityand economicdevelopment can be relatedto one anotherconceptually and substantivelyin a varietyof ways.It is usefulat theoutset to distinguishamong at leastthree differenttypes of relationshipsthat have been proposedby various analysts,although the exact formulationis oftenonly implicit in theirwork. We disregardhere the few works8 which deal with therelatively minor effect of mortalityon economicprocesses and concentrateinstead on income as it causallyaffects mortality level. In orderto simplifythe task,we confinethe review to inter- nationalstudies. 1. Level of IncomeInfluences Level of Mortalityat a Momentin Time Attemptsat empiricalestimation have focused on thecross-sectional relationship between mortality and economiclevel. Most commonly,the relationshipbetween national infant mortality rates and levelsof incomehas been examined.9Coefficients of correlationbetween the variables have been foundto be consistentlyhigh, of the orderof -0 8. The relationshipis sufficientlystrong forinfant mortality rates on occasion to have been used as indicatorsof incomelevels when the requisitedata forcomputing the latter are missing.'0Gordon et al. have suggestedthat the death rateof childrenin theirsecond year of lifemay be a betterindicator of generalhealth levels than 6 InternationalLabour Office, Economic Demographic Modelling Activities of the World Employment Programme. Geneva.Mimeographed, 1973. 7 JohnP. Bongaarts,'A Reviewof the Population Sector in TheLimits to Growth',Studies in Family Planning, 4 (December1973), pp. 327-334. 8 RobinBarlow, The Economic Effects of Malaria Eradication. Research Series No. 15,Bureau of PublicHealth Economics,School of PublicHealth. University of Michigan,1968. 9 IrmaAdelman, 'An EconometricAnalysis of PopulationGrowth', American Economic Review, 53 (1963),pp. 314-339;Leslie Corsa and Deborah Oakley,'Consequences of PopulationGrowth for Health Services in Less DevelopedCountries-An Initial Appraisal', Rapid Population Growth: Consequences and PolicyImplications. NationalAcademy of Sciences,Johns Hopkins Press, Baltimore, 1971; United Nations, Department of Economic and Social Affairs,Report on the WorldSocial Situation.New York,1961. 10 UnitedNations, Economic Commission for Europe, Economic Survey of Europein 1969.Part I. Structural Trendsand Prospectsin theEuropean Economy. New York, 1970. RELATION BETWEEN MORTALITY AND LEVEL OF ECONOMIC DEVELOPMENT 233 infantmortality, which responds to a numberof influences not present at otherages." Frederiksen providespartial support by showingthat death rates at ages 1-4 are moreclosely correlated with grossnational product per head in 15 countriesthan are deathrates at ages0-1, 20-24,or 65-69.12
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