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  • Title: Policies for the reduction of mortality differentials.
    Author: Brass W.
    Journal: Popul Bull ECWA; 1980 Dec; (19):3-27. PubMed ID: 12337640.
    Abstract:
    Effective policies for the reduction of mortality differentials can only be formulated from a knowledge of what these differentials are and some understanding of what determines them. This review draws attention to the present limitations of the information. Before turning to a discussion of policies to reduce mortality differentials, attention is directed to differentials by socioeconomic characteristics in developed countries and to mortality differentials in adult and child mortality in developing countries. Britain has the longest series of differential mortality according to individual characteristics. The classification used was occupation, with later grouping into "social classes." Infant mortality is given in table form by the social class of the father, and male adult mortality is presented in a table for the 1921-1971 period. Differentials were consistently larger for the acute and "environmental" diseases than for congenital anomalies and conditions arising from pregnancy and birth. The standardized indexes of adult male mortality showed a smaller range of variation. A good case can be made for the argument that poor health resulted in changes in occupation and hence a downward move in social class. Studies of characteristics other than occupation in the developed countries are uncommon, but a survey in the United States linked birth and death registration records with a family questionnaire from 1964-1966. In families with a household income of under $3000, the infant mortality was 60% higher than in families with a household income over $10,000. In the developed countries, adult female mortality is lower than adult male mortality at all ages. The cumulative evidence supports the old suggestion that in some developing countries female mortality is, in contast, higher than that of males. The abundance of estimates of childhood differentials in mortality in developing countries makes it necessary to be selective. A particularly systematic comparative study of child mortality was made in Latin America by Behm who examined its implications for the socioeconomic determinants of fertility. The ratio of mortality up to age 2 for children born to women with no education was 3-4 times that for children born with 10 or more years of education. There were differentials by income, occupational class, and urban-rural residence, but these were smaller than that by education and did not explain it. A longitudinal survey in England and Wales revealed significant mortality differentials by family structure. A little evidence exists that this may be even more important in developing countries. Policies to reduce morality differentials must change the environment or operate on the capacities of the families to control it. The evidence is that broad measures to improve the environment or social and health activities will reduce mortality but not socioeconomic differentials so long as the spread of control capacities over families remains the same. Available evidence supports the view that even a modest effort in family welfare policies for the more disadvantaged among the population could result in a good return in reduced mortality differentials.
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