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Global health conditions improved more in the past half-century than in all of the years before [21]. Worldwide, life expectancy has risen to an average of 65 years and death rates have declined, especially among young children [22]. (See Rising Life Expectancy and Declining Death Rates.)
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| Mortality Trends in Children Under Age 5, 1960-95 | ||||||||
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| Source: United Nations Children’s Fund (UNICEF), State of the World’s Children 1997 (UNICEF, New York, 1997). | ||||||||
In the wealthiest countries, average life expectancy climbed from roughly 67 years in 1950 to 77 years in 1995; in the developing countries, life expectancy jumped from 40 to 64 years. Even in the least developed regions, such as sub-Saharan Africa, average life expectancy has climbed from 36 to 52 years. The only exception to these positive regional trends occurred in the transitional economies of Eastern Europe, where life expectancy for men declined from 1989 to 1993. Major strides have also been made in reducing child mortality. As recently as 1950, 287 children out of every 1,000 born in the developing countries would die before reaching age 5. By 1995, that number had dropped to 90 [23].
Yet, this incredible progress should not mask the fact that health conditions remain dismal in many parts of the world, creating huge disparities between the richest and the poorest countries, and indeed, between the rich and the poor within the same country or even city. Today, nearly one fifth of all people in the developing countries are not expected to survive until age 40 [24]. Sierra Leone has the lowest life expectancy in the world – roughly 38 years – less than half that of Japan, which boasts the highest at nearly 80 years [25]. Similarly, without diminishing the huge improvements in child survival, it must be noted that more than 20 percent of children born in the least developed countries will die before reaching age 5; in the richest countries, less than 1 percent will [26].
Just a century ago, health conditions in Europe, North America, and Japan were similar to those of the least developed countries today, as was environmental quality. Conditions in London and other major centers were squalid; sewage-filled rivers, garbage-strewn streets, and overcrowded and dank housing were the norm. Much of the population lacked access to fresh water or adequate sanitation. Epidemics of typhus, cholera, dysentery, tuberculosis, and measles swept these cities. Indeed, in the world’s most prosperous cities at the time, the infant mortality rate – the number of children who die before their first birthday – was more than 100 per 1,000 live births, and in some places it exceeded 200 [27]. Diarrheal and respiratory diseases and other infections were the major causes of death.
By 1950, life expectancy in the most developed countries had climbed to 67 years, and infant mortality had dropped to 58 per 1,000 live births. This remarkable improvement in public health was related to several factors, but chief among them was a concerted effort by both government and non-governmental organizations to improve the environmental conditions of the poor. Appalled by the health conditions of the poor, and increasingly aware that infectious diseases could infect the rich as well, reformers at the end of the 19th Century instituted a series of improvements, known as the Sanitary [28]. Perhaps the most important of these changes was the provision of water and sewage systems for removing human wastes. These fundamental improvements did much to quell the epidemic of infectious disease and contribute to overall improvements in human health and well-being.
Other factors were also at work to improve health over the past century, including rising prosperity, improved nutrition, safer workplace conditions, better housing, and advances in health care – all important determinants of health. Indeed, some 100 years later, the exact contribution of each is still the subject of considerable debate [29]. Environmental interventions clearly played a major role, however, as the most dramatic drops in infectious disease occurred before the widespread availability of vaccines and antibiotics [30][31][32]. (See The Sanitary Revolution and Changing Patterns of Disease.)
| The Sanitary Revolution and Changing Patterns of Disease |
22. World Health Organization (WHO)
23. World Health Organization (WHO)
, The World Health Report 1996: Fighting Disease, Fostering Development (WHO, Geneva, 1996), p. 14.24. United Nations Development Programme (UNDP)
, Human Development Report 1997 (UNDP, New York, 1997), p. 28.25. United Nations (U.N.) Population Division, World Population Prospects, 1950-2050 (The 1996 Revision), on diskette (U.N., New York, 1996), using median estimates of five-year intervals.
26. World Health Organization (WHO)
, Health and Environment in Sustainable Development: Five Years After the Earth Summit (WHO, Geneva, 1997), p. 1.27. David Satterthwaite et al., The Environment for Children: Understanding and Acting on the Environmental Hazards that Threaten Children and their Parents (Earthscan Publications, Ltd., London, 1996), p. 4.
28. World Resources Institute in collaboration with the United Nations Environment Programme, the United Nations Development Programme, and The World Bank, World Resources Report 1996-97 (Oxford University Press, New York, 1996), p. 37.
29. John W. Frank and J. Fraser Mustard,”The Determinants of Health from a Historical Perspective,” Daedalus, Vol. 123, No. 4 (Fall 1994), pp. 5-6.
30. The World Bank
, World Development Report 1993: Investing in Health (The World Bank, Washington, D.C., 1993), pp. 90-98.31. Richard G. Wilkinson, “The Epidemiological Transition: From Material Scarcity to Social Disadvantage?” Daedalus, Vol. 123, No. 4 (Fall 1994), p. 65.
32. Thomas McKeown, The Modern Rise of Population (Academic Press, New York, 1976), pp. 108-109.
