In Search of a Contemporary Theory for Understanding Mortality Change

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Citation: Murray, Chen (1993) In Search of a Contemporary Theory for Understanding Mortality Change.
Internet Archive Scholar (search for fulltext): In Search of a Contemporary Theory for Understanding Mortality Change
Tagged: uw-madison (RSS), wisconsin (RSS), sociology (RSS), demography (RSS), prelim (RSS), qual (RSS), WisconsinDemographyPrelimAugust2009 (RSS)

Summary

Classic explanations for mortality decline are improvements in living standards created by economic expansion and, its rival, the intervention of public health and application of modern health technologies. To these two theories has been added an explanation which focuses on sociocultural and behavioral factors. However, Murray and Chen argue that none of these theories adequately explain "the astounding [long-term] resilience and insensitivity of secular mortality declines to respond to powerful [short-term] countervailing forces," such as economic recession, famine and even war (p. 143). That is, while social and economic disruption may temporarily increase mortality rates, these disruptions have not fundamentally disrupted the general trend of secular mortality decline. This article therefore sets out to examine the inadequacies of existing theories and to offer an alternative explanation. According to the standard of living/nutritional status hypothesis, the "global recession and the debt crisis in the early 1980s . . . should have resulted in a slowdown or reversal of mortality decline" (p. 144). The mediating factors between economic dislocation and mortality increase were postulated to be reductions in family expenditures (e.g., food), particularly in poorer regions and reduced government expenditures for social services. UNICEF concurred with the standard of living hypothesis and "argued that economic deprivation would stop or reverse trends in child health improvements" (p. 145). Although mortality did increase temporarily among some subgroups, mortality declines at the national level persisted right through the economic crises. Examples more extreme than economic dislocation come from famines and wars. In Bangladesh, war in 1971 was followed by famine in 1974-75. Combined, these catastrophic events caused mortality to increase by about 35%. However, incredibly, within two years after the end of these crises, mortality levels returned to "the longer-term secular trend that would have been attained had the war and famine not occurred" (p. 146). This evidence reveals faults in the economic approach. But weaknesses also exist in the public health/medical technology and sociocultural/behavioral explanations. For instance, "technology application has been weakest precisely in those societies that have experienced the most severe economic setbacks," which clearly suggests that the application of medical technology cannot substitute for income as an explanation for the persistence of declining mortality (p. 149). Furthermore, many facets of health are simply beyond individual control (e.g., exposure to airborne diseases), limiting the explanatory power of the behavioral approach. "The importance of income, technology, and behavior on mortality change, however, should not be discounted. Rather, the weakness of existing theories rests more on their incompleteness, insufficiency and lack of subtlety rather than their validity. Especially lacking is a framework that would integrate together the potential roles of all three factors-income, technology and behavior" (p. 149). So, Murray and Chen propose an integrative approach. Another novel aspect of their "Theory of Assets" is the focus upon health stocks rather than flows. Stocks-such as infrastructure, health care facilities (both physical assets), and education (social assets)-are built over a long period of time, and are not easily eroded by short term crises. Conversely, flows-such as calorie intake and immunization coverage-may vary greatly over short periods of time. Therefore, Murray and Chen argue that health stocks are responsible for the persistent improvement of mortality despite periodic deterioration in health flows.