2018/04/14 by Wolfgang Lutz, Endale Kebede, Endale Birhanu Kebede · 2 citations
Health Professions · Medicine · Social Sciences · #Birth, Development, and Health #Global Health Care Issues #Health disparities and outcomes
paper · pdf · doi:10.1111/padr.12141
openalex publication_date 2018/04/14 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
Progress in human health and life expectancy is closely associated with socioeconomic development. Better nutrition and greater affordability of health care associated with higher income have been widely considered as primary determinants of historical and contemporary mortality declines. McKeown's (1976) influential book on the modern rise of population attributed the secular mortality decline largely to improving standards of living. Reviewing mortality improvements in Britain during the second half of the nineteenth century and the beginning of the twentieth, he argued that medical discoveries were of little consequence for the significant gains in survival during this period. His analysis served as a reference point of Preston's (1975) article, which is the focus of the present study. Preston showed that the global pattern over the twentieth century indicates an upward shift of the curve that links GDP per person on the horizontal axis and life expectancy on the vertical (Figure 1).1 Preston interpreted this shift as the effect of medical progress and health care over and above the effect of income. In many of the studies of this issue that followed Preston's lead, the assumption that income is the most important driver of mortality decline has been an unquestioned starting point.