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More recently, Vallin and Meslé (2005: 85), conditions and a decline in mortality. In
reformulated this hypothesis: 1800, the global average life expectancy
at birth was about 28.5 years. Over the next
Arguably, each major improvement in the matter
of health is likely to first lead to a divergence in 100 years, it improved very little, reaching
mortality since the most favoured segments of the 32.0 years in 1900. However, much more
population benefit most from the improvement. rapid progress occurred in the first half of the
When the rest of the population accesses the ben- twentieth century, when life expectancy
efit of the improvement (through improved social
conditions, behavioural changes, health policies, increased by 14 years and reached 46.4 years
etc.), a phase of convergence begins and can lead during 1950–1955. Progress was faster
to homogenization until a new major advance during the latter part of the century when
occurs. The entire health transition process thus global life expectancy rose to 66.0 during
breaks down into successive stages, each including 2000–2005 (Riley, 2005; UN, 2007). In
a specific divergence-convergence sub-process.
Europe, which has led the demographic tran-
There is a growing body of evidence that sition, the pattern was more pronounced.
suggests that despite impressive achieve- During the first half of the century, life
ments in reducing mortality and extending expectancy rose from 42.7 years in 1900 to
life expectancies, many populations and par- 65.6 years during the period 1950–1955 and
ticularly those in disadvantaged groups have to 73.8 years during 2000–2005. In Europe,
remained in the early stages of the epidemio- the largest reductions in mortality occurred
logical transition, where communicable and from declines in air-borne and water-borne
infectious diseases including pneumonia, infectious and communicable diseases,
diarrhoeal diseases, malaria, measles, and resulting from large improvements in public
tuberculosis are still the major cause of health provisions such as sewage and water
death. Some analysts argue that under the supply, better availability of food and
forces of globalization, health gains in a improvements in nutrition, and the dissemi-
number of developing and less-developed nation of hygienic knowledge among, popu-
countries have not been shared equally and lations, rather than from improvements in
the conflict between needs and resources has public health technology (McKeown, 1976).
continued to persist. The competition for the It was only during the latter phases when
available resources has mainly benefited the medical advancements (such as inoculation
better-off, while certain segments, especially and vaccination for smallpox, cholera, tuber-
women, children, and the poor have been left culosis) helped reduce mortality further.
behind. The less privileged continue to live in In the less developed parts of the world,
poorer health conditions and when stricken progress was much slower, although the
by a disease or disaster they are more likely regions exhibit enormous variations in mortal-
to die than are the more privileged (Cornia, ity and socioeconomic development. For
2001; Ram, 2001; Sen and Bonita, 2000; example, for the period of 1950–1955, life
Wilkinson, 1996; World Bank, 2003). This expectancy at birth in Asia was only
phenomenon could be referred to as ‘epi- 41.0 years, and in Africa it was only 38.5 years,
demiological polarization’ as Frenk et al. lower than that observed in the Americas
(1989: 31) have labelled it. and Europe fifty years before (41.0 and
42.7 years). However, progress was made rather
quickly in several countries, while there was
little change in many others. Between 1950 and
OVERALL TRENDS IN HEALTH, 1955 and 2000 and 2005, life expectancy rose
ILLNESS, AND MORTALITY from 41.0 to 67.5 years in Asia and from
51.4 to 72.0 in Latin America and the
Looking from a long-term perspective, there Caribbean. China’s experience was exemplary,
has been a worldwide improvement in health where life expectancy rose from 40.8 years