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