Caselli et al. 2022

Introduction

• Omran’s theory
• Introduction of the 4th stage of epidemiologic transition: maximum point of convergence of life expectancies (85 years) increase due to the achievements in the treatment of cardiovascular diseases
• Goal of the article: study the exceptions observed since 1960s in the general trend of increasing life expectancy

From Convergence to Divergence

• Rise of man-made diseases was curbed by efficient policies
• Revolution in the treatment of cardiovascular diseases
• After WWII, most countries made huge progress and joined the general trend of convergence of increased life expectancy
• However, countries in Africa weren’t able to reach a pace of progress sufficient to reduce the gap separating them from developed countries
• Many countries of tropical Africa are advancing at a much slower pace than other countries with similar life expectancy levels
• AIDS epidemic triggered a sharp decrease in life expectancy levels in many African countries
• Exceptions: Sub-Saharan Africa + Eastern Europe

Sub-Saharan Africa: An Unfinished Second Phase

• None of the countries in Sub-Saharan Africa have been able to catch up with developed countries
• Some countries had their life expectancy declined over the last 2 decades
• 2 problems:
  • These countries have failed to make rapid advances in the field of health
  • All progress if any stopped towards the end of the 1980s due to AIDS, the economic crisis, and the reappearance of infectious diseases

Slower Progress than Might Have Been Expected

• In almost all African countries: infant and child mortality declined significantly at a slow pace
• Examples: Niger, Ghana
• In most countries in Sub-Saharan Africa: infant and child mortality did not decrease rapidly
• Arrival of AIDS: pull many African countries back to life expectancy levels that were prevalent at the beginning of the second transition
• Impact of wars + political violence, which is frequent in Africa
• Rwanda’s genocide: reduced life expectancy
• Second phase of the epidemiologic transition is far from having ended in Africa due to: slowness of health care advances + impact of AIDS

Eastern Europe: The Fourth Phase Has Yet to Begin

Reemergence of the East-West divergence

• None of the Eastern European countries took part in the health improvements made by most industrialized countries since the 1970s

Specific Eastern Europe trends

• Countries of the former Soviet Union: male life expectancy underwent a sharp decline and female life expectancy stagnated
• Life expectancy started to fluctuate in 1985

Atypical Age Patterns

• Decline of life expectancy in Eastern Europe: linked to the uncommon distortion of the structure of age-specific mortality
• Excess mortality in the ages 25 and 55 both for male and female

The Importance of Cardiovascular and Man-Made Diseases

• Eastern countries were unable to curb the increase in mortality due to cardiovascular diseases
• Mortality related to alcohol consumption
• Increase in man-made diseases: deteriorated the health situation

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