Conclusions

Whether one is considering mortality in highly developed or less developed countries, similar questions frequently emerge: To what degree have public health and therapeutic interventions made a difference? To what degree has economic development been responsible for increasing life expectancy? And to what degree are changes in individual behavior important?

It is generally agreed that in the developed countries development itself has been responsible for most of the change. In contrast, much of the improvement in mortality in less developed countries is said to have been caused by imported public health measures, especially those that could be widely and inexpensively applied in the absence of fundamental changes in the socioeconomic characteristics of the population itself.

More evident disagreement surrounds the question of what is required to reduce mortality further in less developed countries: relatively modest technical assistance from abroad and a domestic policy of literacy and equitable food availability or major socioeconomic change. In developed countries, disagreement has to do with the degree to which individual behavioral changes, on one hand, and environmental changes, on the other, have been important, as well as what will be the future role of biomedical research and health care in addressing the health care problems of the very old. The questions are fraught with political implications and the answers are by no means obvious.

Stephen J. Kunitz

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