What are the Causes of Decline of Mortality Rate in Developed Countries?

In Europe, North America and Oceania, continuous economic progress, resulting from Agricultural and Industrial Revolutions, has been the main reason for the reduction in mortality rates, which first began to decline rather weakly in the seventeenth century, and then with an increasing tempo throughout the eighteenth and nineteenth centuries.

In the twentieth century mortality has continued to decline, at a slower rate. Some ten factors have been enumerated as having contributed towards the reduction in mortality rates in the developed countries.

One important development affecting mortality in European countries since the eighteenth century was the increase in the supply of food.

With the Agricultural Revolution, which began in England around 1700 and spread throughout Europe and the European settlements, abroad, the productivity of land and labour began to increase, the risk of crop failure was reduced and the supply of food became fairly steady.

The system of rotation of crops, the development of improved strains of plants and animals, the introduction of new crops and improved farm machinery were some of the important outcomes of the agricultural revolution.

With the increase in the quantity and quality of food, mortality rates in Europe and European overseas settlements came down.

Further advances in agricultural technology during the nineteenth and the twentieth centuries, which included the introduction of artificial fertilisers and the mechanisation of agriculture, freed labour from the necessity of working on land for food production, so that they could engage themselves in different types of manufacturing activities.

With the development of the steam engine, it became possible to transport and distribute surplus, food from one area to another where scarcity conditions prevailed.

The frequency of localised famines was thus arrested. Better methods of storing food also helped to mitigate the serious effects of famines.

The real income of the people gradually increased, and the availability of enough nutritious food brought about mortality declines. In fact, McKeon and Record are of the opinion that better diet was probably the main cause of the substantial fall in mortality from tuberculosis in England and Wales.

The advances in technology and improvements in the standards of living aided the fall in mortality in many other ways. Heavy and better clothing to combat severe winters became available and health services and medical research activities were extended.

Another important factor which contributed to the reduction in the mortality was improvements in sanitary conditions and public health measures.

Sanitary reforms were introduced in England in the nineteenth century following the Sanitary Reform Movement which was started to combat the many evils of the Industrial Revolution.

State Governments, which had so far not taken much interest in introducing sanitary reforms, began to do so by introducing several public health measures and sanitary improvements, such public utilities for the provision of water supply, purification of water, sewage disposal, etc.

By the beginning of the twentieth century, most of the cities in the Western world and Russia had developed the drainage system and provided pure and protected water.

The disinfection of water by chlorination came into practice at the turn of the century, with the result that many communicable waterborne diseases such as cholera, diarrhoea and dysentery were brought under control.

The relationship of filth and congestion to diseases was recognised even before the discovery of the microbial origin of communicable diseases. Personal and community cleanliness became the central theme of the Hygiene Movement.

Soap, which was hitherto taxed as a luxury item, came into common use in the nineteenth century. The substitution of cotton under-garments may also have contributed to personal hygiene, as cotton garments can be easily and frequently washed.

The growing importance of personal cleanliness was considered to be the main factor in the disappearance of typhus, a disease transmitted by the body louse.

It was made compulsory for private and public bodies to notify the authorities of the outbreak of major communicable diseases, and quarantine restrictions were imposed whenever necessary.

The number of hospitals and tuberculosis sanatoria increased. Even at the school level, the practice of routine medical examination of children was introduced and medical consultancy services were provided to pre­school-age children.

Social reforms in the nineteenth and twentieth century’s lessened the hazards of working in the factory early in life. Legislation bearing on the number of working hours and minimum wages was enacted, and working conditions improved because of the various safety devices that were introduced.

The social security system provided benefits like old-age pensions, health insurance, medical care, unemployment insurance, etc. The introduction of free and universal compulsory schooling resulted in mass literacy and the inclusion of personal and social hygiene in school curricula helped in creating a greater awareness of the necessity of health among the people.

In the late nineteenth century, the development of asepsis (precautionary exclusion of pathogenic micro organisms) and antisepsis (killing or inhibiting the growth of micro organisms already present) helped in the reduction of mortality.

Aseptic and antiseptic surgery was introduced and the germ theory was accepted in various other aspects of life such as preservation of food through pasteurisation and sterilisation.

The development of immunology was yet another cause of the declines in mortality. Immunisation against small-pox was introduced first. This was followed by the development of vaccines for chicken-pox, cholera, sheep anthrax, hydrophobia and diphtheria.

Prophylactic antitoxins were also introduced against tetanus, typhoid, yellow fever, scarlet fever, polyomyelitis, influenza, measles, whooping cough etc.

Advances in chemotherapy (use of drugs to cure or inhibit the progress of diseases) began in the late 1930s. Sulfonamides and penicillin in the treatment of respiratory and urinary tract infections came to be widely used in the control and cure of various kinds of diseases.

As consequences of the use of these broad spectrum antibiotics, mortality from communicable diseases declined substan­tially. After the Second World War, there have been considerable declines in mortality following the use of anti-tuberculosis drugs.

The development of effective insecticides such as DDT has greatly reduced the incidence of insect-borne diseases such as typhus and malaria. Anti-malaria campaigns have practically wiped out this disease from many countries.

It has also indicated that there has been a change in the virulence of the disease-causing organisms and/or an increase in the resistance of the human host Mortality from small-pox, scarlet fever and diphtheria is believed by some writers to be affected by such factors.

The reason for the disappearance of one of the biggest killers, plague, from Western Europe since the middle of the seventeenth century has continued to remain a mystery.