Toward sociomedical health indicators

The various forms of mortality data and biomedical measures of morbidity have become inadequate measures of the level of health in economically developed countries. Measures of functional physical capacity have some advantages but do not reflect physical impairment. Current attempts to develop sociomedical health indicators include: measures of social disability; typologies of presenting symptoms, which have been used to estimate probable needs for care; measures which focus on behavioral expressions of sickness; research based on operational definitions of ‘positive mental health’, ‘happiness’ and perceived quality of life; assessments of met and unmet needs for health care, which are measures of social capacity to care for the sick. Sociomedical indicators reflect both objective conditions and social values. They are policy-oriented, serving as mobilizing agents for sociopolitical pressures concerned with raising the overall level of health of the population.     

Famine,Maternal Nutrition and Infant Mortality: A Re-examination of the Dutch Hunger Winter

During the Dutch Hunger Winter (1945), a unique, documented example of mass famine in an industrialized population, total reproductive loss (fetal and infant mortality) among most exposed mothers remained relatively low. This is explained by highly favourable fetal mortality and unfavourable infant mortality. The author traces the pattern of low fetal mortality to the higher levels of ‘embodied health status’ of famine mothers. The high infant mortality of the famine area testifies to the severity of the food and fuel shortage, yet another factor held down the rate of stillbirth. This other factor, it is argued, has a socio-economic character, it is the intrinsic ‘embodied’ nutritional status of the regional population, arising from favourable opportunities for growth and development among successive generations of mothers. This explanation highlights the importance of maternal vitality, (a synthetic, historically variable and culturally determined phenomenon) as a neglected feature of historical demography.     

多维度失能测度指标体系构建及失能分级研究

以ICF理论框架的交互影响理念为依据,从多维度视角构建了失能测度指标体系。首先,通过赋值法,得到多维度下的失能总分,依据得分将其划分为重度失能、偏重度失能、中度失能、轻度失能及健康五种功能状态,构造死亡概率模型及失能状态转移概率模型,结果显示,失能分级标准是可靠的。其次,利用CLHLS数据库2011年及2014年追踪调查数据,通过构造多状态转移概率矩阵,实证测算了多状态失能转移概率;借助第六次全国人口普查数据,估算了中国65岁及以上失能人口规模、各状态维持时间及预期寿命等。结果显示,初始健康的老人三年期转移概率维持在健康的概率最高,其死亡率也最低;而初始状态为重度失能的老人死亡率最高,其维持重度失能及转移到偏重度等失能状态的概率也最高。研究结论表明,直接依据数据的失能状态转移概率测算比建模估计要准确;基于多状态转移概率矩阵评估的失能规模、预期寿命等均比已有分级测度结果可靠性更高。     

There is no low-level fertility and development trap

The theory of the low-level equilibrium trap asserts that an increase in income stimulates population growth sufficiently so that the additional people ‘eat up’ the ‘surplus’ over subsistence, and hence drive the level of income back to subsistence. Originally the theory referred primarily to mortality, but nowadays its application is to fertility. In the long-run equilibrium context in which the theory is ordinarily presented, the fact that the long-run elasticity of fertility with respect to income is negative in less developed countries fatally contradicts the accepted version of the trap. But to give every chance for trap theory to be meaningful, the paper presents a period-by-period analysis, embodying larger-than-observed positive elasticities during the early years and the logically necessary counterbalancing negative elasticities during the later years. These elasticities are combined with consumption and production figures for various age groups to estimate the effect in each year after the windfall, and altogether. The results show that even under assumptions not charitable to the conclusion of this paper, additional children do not even come close to ‘eating up’ the increase in income which induced their births, so that the trap theory is falsified.     

The weighting of an international health status index

The major purpose of this paper is to suggest possible weights for a global index of health status. The indicators for the global index are taken from the World Health Organization's definition of health as physical, mental and social well-being. These indicators are combined with mortality indicators to arrive at a finalized index. Survey methodology is used to make initial estimates of the weighting of appropriate indicators, based upon a sample of international health scholars. Preliminary results indicate that mortality is weighted 40%, physical health (morbidity and disability) 25%, mental health 15%, and social health 20%. These results are intended as a starting point for future research.     

Does the Hispanic Paradox in U.S. Adult Mortality Extend to Disability?

Studies consistently document a Hispanic paradox in U.S. adult mortality, whereby Hispanics have similar or lower mortality rates than non-Hispanic whites despite lower socioeconomic status. This study extends this line of inquiry to disability, especially among foreign-born Hispanics, since their advantaged mortality seemingly should be paired with health advantages more generally. We also assess whether the paradox extends to U.S.-born Hispanics to evaluate the effect of nativity. We calculate multistate life tables of life expectancy with disability to assess whether racial/ethnic and nativity differences in the length of disability-free life parallel differences in overall life expectancy. Our results document a Hispanic paradox in mortality for foreign-born and U.S.-born Hispanics. However, Hispanics’ low mortality rates are not matched by low disability rates. Their disability rates are substantially higher than those of non-Hispanic whites and generally similar to those of non-Hispanic blacks. The result is a protracted period of disabled life expectancy for Hispanics, both foreign- and U.S.-born.     

Health indicators or health system analysis? Extracts from a French survey

The conclusions of a french study devoted to the problem of health Indicators are exposed and summarized in this later. After a review of statistical data available in France in the field of health and medicine, the theoretical problems linked with the meanings of the concepts of ‘need’, ‘morbidity’ and ‘state of health’ are examined. A system analysis of this sector is proposed, considered as a formal framework necessary for interpretation of data which seems preferable to the different essays on aggregation in a unique quantitative health index.     

Changes in the age dependence of mortality and disability: Cohort and other determinants

Though the general trend in the United States has been toward increasing life expectancy both at birth and at age 65, the temporal rate of change in life expectancy since 1900 has been variable and often restricted to specific population groups. There have been periods during which the age- and gender-specific risks of particular causes of death have either increased or decreased. These periods partly reflect the persistent effects of population health factors on specific birth cohorts. It is important to understand the ebbs and flows of cause-specific mortality rates because general life expectancy trends are the product of interactions of multiple dynamic period and cohort factors. Consequently, we first review factors potentially affecting cohort health back to 1880 and explore how that history might affect the current and future cohort mortality risks of major chronic diseases. We then examine how those factors affect the age-specific linkage of disability and mortality in three sets of birth cohorts assessed using the 1982, 1984, and 1989 National Long Term Care Surveys and Medicare mortality data collected from 1982 to 1991. We find large changes in both mortality and disability in those cohorts. providing insights into what changes might have occurred and into what future changes might be expected.     

Trends in health expectancies in Australia 1981–1993

Health expectancy indices combine the mortality and morbidity experience of a population into a single composite indicator. This paper summarizes and evaluates methods for the calculation of health expectancies and presents trends in the expectation of life with disability and handicap in Australia from 1981 to 1993. Unlike other countries for which recent health expectancy time series are available, Australian results indicate that the expectation of years with disability has increased for both males and females. Possible explanations for this are examined.     

Famine Mortality in Nineteenth-Century Japan: The Evidence from a Temple Death Register

Economic and demographic historians who have studied Japan's early modern period argue that preventive checks to fertility were the primary cause of Japan's stationary population in the eighteenth and early nineteenth centuries, and that the role of ‘positive’ checks was negligible. This paper presents evidence and a claim that mortality crises – famines in particular – also played an important role in checking population growth during this period. It analyses data from the death register of Ogen-ji, a Buddhist temple in the Hida region of central Japan. These data provide a remarkably detailed picture of the short-term demographic consequences of Japan's last great famine, the Tenpō famine of the 1830s. ‘Normal’ mortality patterns, by age and sex, are compared with patterns of mortality during the famine. Mortality of males rose considerably more than that of females, with the greatest rise occurring among young boys aged 5–14 and adult men aged 30–59. A surprising finding was that mortality at ages 0–4 rose relatively little, in part a consequence of a marked fall in the number of births during the famine. The Tenpō subsistence crisis was not the sole cause of population stagnation in the Ogen-ji population, but it was a prominent feature of the ‘high mortality regime’ that this population experienced during the eighteenth and nineteenth centuries.     

The Relation Between Actual and Intrinsic Growth Rates

This paper demonstrates that, to a close approximation, the intrinsic growth rate of a population is equal to the mean of age-specific growth rates below age T, the mean length of a generation. This mean is normally close to the growth rate of the entire population block below age T. Therefore, when a disparity exists between the intrinsic growth rate and the actual growth rate of a population (whether or not net migration is included in both rates), it must be attributable to an unusual growth rate of the population block above age T. One implication is that the ‘momentum of population growth’ is entirely confined to the age span above T, approximately age 28 in developing countries to-day.     

The role of a provincial hospital: The Norfolk and Norwich hospital, 1771–1880

Up to the mid-1950's most economic and social historians accepted that improved medical measures, notably the expansion of hospital facilities, made a significant contribution to population growth in the late eighteenth and early nineteenth centuries by helping to reduce mortality rates. In an article which first appeared in 1955, T. McKeown and R. G. Brown criticized what had become the ‘traditional’ view. Though the number of hospitals increased, and though there were advances in medical education and knowledge, such developments, McKeown and Brown suggested, were of little value to the population until reflected in improvements in the standards of treatment available. ‘In assessing the contribution of hospitals to the reduction of mortality’, they argued, ‘we are less concerned with the number of beds than with the results of treatment of the patients who occupied them’.     

Infant Mortality Rate as a Measure of a Country’s Health: A Robust Method to Improve Reliability and Comparability

Researchers and policymakers often rely on the infant mortality rate as an indicator of a country’s health. Despite arguments about its relevance, uniform measurement of infant mortality is necessary to guarantee its use as a valid measure of population health. Using important socioeconomic indicators, we develop a novel method to adjust country-specific reported infant mortality figures. We conclude that an augmented measure of mortality that includes both infant and late fetal deaths should be considered when assessing levels of social welfare in a country. In addition, mortality statistics that exhibit a substantially high ratio of late fetal to early neonatal deaths should be more closely scrutinized.     

On the Survival of Centenarians and the Span of Life

It has been argued in the literature that the observed mortality crossover among older black Americans relative to the white population is a result of ‘differential early mortality which selects the least robust persons from the disadvantaged population at relatively earlier ages so that, at advanced ages, the disadvantaged population has proportionately more robust persons’ (Kenneth G. Manton). The authors examine the plausibility of the observed black mortality crossover and the heterogeneity argument supporting its existence. In addition to citing evidence from the literature, they use life tables from various countries known to have good mortality data to explore the relation between mortality in childhood and at younger adult ages and mortality in old age for cohorts and periods. Analysis suggests that the association between childhood and old-age mortality for cohorts is positive, implying that observed mortality crossovers are produced by deficient data rather than population heterogeneity.     

The calculation of mortality-rates in the construction of life tables. A mathematical statistical study

Official life tables are frequently calculated for a period of years, rather than for an individual year, and the question arises, how annual rates are to be combined, in order to give an indication of the average mortality of the period. The author examines this problem, and uses methods based on the binomial probability distribution to suggest a solution of the ‘weighting’ problem. Taking as his starting-point the work of the Dutch statistician Van Pesch, he modifies the latter's theory so as to make it applicable to the case, where mortality rates have a secular downward trend, and reaches the conclusion that the ‘most probable values for the mortality rates are not obtained by applying the weighted mean, but by the application of a weighted mean and a correction term. The inclusion of the correction term means that, practically speaking, the results do not differ from those obtained by the application of the unweighted mean. The unweighted mean, which has the advantage of requiring less computational work, may therefore be given preference over the theoretically more accurate method.’     

分年龄组死亡率变动对人均期望寿命影响的实验研究 ——以甘肃省为例

人均期望寿命是分析、评价人口健康状况,衡量社会经济发展及医疗卫生服务水平的重要指标。从2014年开始人均期望寿命的提高被纳入卫生计生系统考核内容,受到各级政府的重视。为了有效地甄别和评价政策实施对人均期望寿命提高的贡献程度,需要精确地估计和判断各年龄组死亡率变动对人均期望寿命提高的影响。在实践中,针对某一年龄组或某一特定人群死亡率的变动以及相关政策实施对人均期望寿命的影响鲜有较为精确的定量解答或快速有效的估算办法。本研究通过数据实验方法和计算机辅助计算建立一套可以较为精确地估算某一区域内某一年龄组死亡率变动对人均期望寿命影响的计算方法和结果集,利用这种方法可以开展不同类型、不同区域内人口死亡率变动对人均期望寿命影响的快速估算。利用估算结果可以对区域内政策实施效果进行较为科学的评估或评价。文章以中国2010年人口普查数据中甘肃省各年龄组分性别死亡率数据为基础对上述研究进行实证分析和验证。     

The momentum of mortality change

Mortality change is not usually assigned much importance as a source of population growth when future population trends are discussed. Yet it can make a significant contribution to population momentum. In populations that have experienced mortality change, cohort survivorship will continue varying for some time even if period mortality rates become constant. This continuing change in cohort survivorship can create a significant degree of mortality-induced population change, a process we call the ‘momentum of mortality change’. The momentum of mortality change can be estimated by taking the ratio of e ₀ (the period life expectancy at birth) to CAL (the cross-sectional average length of life) for a given year. In industrialized nations, the momentum of mortality change can attenuate the negative effect on population growth of declining fertility or sustained below-replacement fertility. In India, where population momentum has a value of 1.436, the momentum of mortality change is the greatest contributor to its value.     

Mortality and Metropolis: The Case of London 1675–1825

Recent work in population history emphasizes that demographic phenomena should be seen in a wider social and economic context. This perspective is, however, more easily achieved in the case of fertility than of mortality, which is widely treated as a variable ‘exogenous’ to economy and society. In the present paper it is argued that the inclusion of spatial structure and migration in accounts of historical demographic regimes can restore long-term variations in mortality to an ‘endogenous’ position. Within such a model a central role is played by large metropolitan populations, which act as endemic reservoirs of infection, with high but relatively stable levels of mortality. Data from the annual London Bills of Mortality allow empirical testing for the period 1675–1825, with results which generally conform to theoretical expectations, although a substantial reduction in mortality occurs during the latter part of the period.     

Remeasuring ageing in Hong Kong SAR; or ‘keeping the demographic window open’

Hong Kong SAR has among both the lowest fertility rates and highest life expectancy in the world. Under the current calculation of the Old Age Dependency Ratio (OADR), Hong Kong is, understandably, ageing extremely rapidly. This is a cause of significant concern among policy makers. However, OADR assumes that the entire population aged above 65 is both ‘old’ and ‘dependent’, neither of which is clearly defined, and that all aged below 65 are active in the labour force. Furthermore, because the rate is fundamentally based upon a European/North American model of pension and retirement it is arguably less appropriate to areas of the world where retirement ages are more fluid and pension systems less developed. We apply and extend a method for Hong Kong, designed by Sanderson and Scherbov, to ‘remeasure ageing’ by taking remaining life expectancy as the constant, rather than years lived by using projected life tables and 1 × 1 population projections. In doing so, we show that Sanderson and Scherbov’s new ‘prospective’ measurements of ageing more accurately reflect the increased longevity and vitality of Hong Kong’s population. Rather than passively accepting fate as a ‘rapidly ageing’ population, East Asian economies can be active in rethinking society’s relationship to work and other activities across the life-cycle. By adapting existing measurements to take into account the different welfare regimes in East Asia, we can radically alter the timeframe in which population ageing becomes ‘critical’. This allows more time to develop a more holistic life-course view of the relationship between work, longevity and fertility and to actively tackle ageing in an optimistic way.     

Summary indices of the age distribution of a population

In this paper a method for characterizing the age distribution of a population by means of an ‘index word’ is outlined. It is shown that the method can be applied to yield approximations to population forecasts.