The promotion of research into leveis, patterns, trends, and causes of mortality has been a primary concern of the International Union for the Scientific Study of Population (IUSSP) since its inception. For several decades, the activities of the IUSSP in relation to mortality studies have emphasized the need to provide reliable, sensitive tools to monitor and assess trends in child survival. This coincided with the focus of the international public health community on the prevention and control of infectious diseases. At the same time, evidence has been accumulating that the survival prospects of infants and children have increased markedly in many parts of the developing world, particularly Latin- America and East Asia, due in large part to the successful and sustained implementation of primary health care strategies. Concomitant with these successes, the chronic diseases have begun to emerge as major public health issues in a number of developing countries. The nature and extent of this epidemiological transition varies between countries, but essentially it is characterized by the progressive replacement of the leading causes of child death (i.e. acute-respiratory infections, diarrhoeal diseases, vaccine-preventable diseases, and malaria) by the major chronic diseases such as cardiovascular diseases and cancer, which are much more common among adults and the elderly.
It was with this realization in mind that the IUSSP Council decided in 1989 to establish a Committee on Adult Mortality, chaired by Alan Lopez of the World Health Organization, to prepare a series of scientific seminars on adult health and survival. The first of these seminars was concerned with causes and prevention of adult mortality in developing countries and was held in Santiago, Chile, in October 1991, being jointly sponsored by CELADE and the Pan American Health Organization. A second seminar on adult mortality in developed countries took place in Taormina, Italy in June 1992, bringing together epidemiologists, demographers, and other social scientists. The third and final seminar convened by the Committee was held in Sendai City, Japan, from 21-5 June 1993, entitled Health and Mortality Trends Among Elderly Populations: Determinants and Implications. This book is based on the thirty- one invited papers presented and discussed at the seminar.
The challenge in developing future public health and social policies for the elderly arises from three major trends in the characteristics of the elderly population. The first of these is the rapid increase in the number of old people, and especially the very old. As the effects of fertility change on age structure