Academic journal article Population

Do Vanguard Populations Pave the Way towards Higher Life Expectancy for Other Population Groups?

Academic journal article Population

Do Vanguard Populations Pave the Way towards Higher Life Expectancy for Other Population Groups?

Article excerpt

Overall progress in reducing mortality during the second half of the twentieth century went together with unprecedented growth in mortality inequalities between countries (Caselli et al., 2002; McMichael et al., 2004; Moser et al., 2005). This can be interpreted in the framework of health transition theory (Frenk et al., 1991; Meslé and Vallin, 2002, 2006) enriched by the assumption that each major epidemiological development initially gives rise to divergence in mortality trends (Vallin and Meslé, 2004). Even developed countries differ greatly in their degree of advancement in the health transition; while some countries are still fighting against cardiovascular diseases, others have successfully completed this stage and are entering a new phase of transition where life expectancy gains will increasingly depend on progress in combating cancers, mental disorders and other age-related degenerative diseases (Vallin, 2005). One of the most illustrative examples of this divergence is the emergence of an east-west mortality divide in Europe following the cardiovascular revolution. While western Europe was striding ahead in this area, central and especially eastern Europe have yet to emerge from a long-term health crisis that led to stagnation and even decline in life expectancy in the 1970s (Vallin and Meslé, 2004; Meslé, 2004). In this respect, some advanced countries may be considered as pioneers or vanguards, opening a path towards lower mortality, while others, unable to profit from these innovations, lag behind (Oeppen and Vaupel 2002; Vaupel 2003). Vanguard countries benefit sooner from progress because of more favourable contextual factors, including their capacity to disseminate and implement medical advances across the whole population.

During the last few decades, similar divergence in mortality trends has been observed at the sub-population level (Valkonen, 2001; Mackenbach et al., 2003; Shkolnikov et al., 2006, 2012). In Finland, mortality decreased continuously over the 1970s-1990s, but unevenly across different social and marital status groups (Martikainen et al., 2005). In particular, mortality reductions were slower in groups with higher starting levels of mortality, and faster in groups with the lowest starting levels. These trends have led to a widening of relative mortality differences by socioeconomic status and by marital status (Valkonen, 2001; Martikainen et al., 2005; Murphy et al., 2007).

Long-term increases in mortality differences between population groups in developed countries can also be interpreted using the same convergencedivergence framework within the health transition theory (Vallin and Meslé, 2005). As is the case at country level, the advantaged population groups also benefit first from new favourable conditions such as access to the most advanced medical technologies or improved living conditions. It takes time for the rest of the population to catch up with more advanced population groups in terms of resistance to disease and death. For example, Valkonen (1997) showed that it was not until the 1990s that manual workers reached the life expectancy already enjoyed by non-manual workers in the 1960s.

Research devoted to mortality differentials focuses primarily on the magnitude of these differences or on the unfavourable mortality situation of the disadvantaged groups. This is understandable because mortality inequalities are a matter of ethical concern and a prime target of health policies (Peter and Evans, 2001; Venkatapuram, 2011). At the same time, the populations with the lowest mortality receive much less attention, even though the best practice (or vanguard) groups within national populations are establishing the new frontiers of survival and longevity that will eventually be reached by others (Desplanques, 1973; Martelin, 1996; Valkonen, 1997). Could vanguard groups be considered as predictors of the future mortality of other groups and of entire populations?

Previous research using the same data found striking increases in absolute and relative mortality disparities by education in Finland, Norway, and Sweden (Shkolnikov et al. …

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