Abstract

PIP: Criticism is directed to an article published by Cleland et al. in the April 1992 issue of Health Transition Review. The concern raised is that interpretative results were not impartial and were "extremely incautious." The possible relationship between mortality and the economy would be in its indirect effect or education, or in changes in employment from agricultural to nonagricultural with accompanying loss of income and deteriorating environmental conditions. Cleland et al. also do not explain why the principle of convergence might occur, where the more poorly educated groups would be able to improve the survival chances of their children better than well educated groups. In the final summary of their paper there is mention that convergence which did not appear in their data set followed a similar pattern as in developed countries. Since developed countries show different patterns, perhaps the egalitarian nature of the country is not an explanation for the mortality differentials. The suggestion is made that "response to illness" may be more important than prevention. The data do not support this view, and even reference to Demographic and Health Survey morbidity data as showing smaller social differentials is only "after the fact" and only theoretically plausible. Crook et al. has argued that curative medicine is responsible for the decline in urban mortality; mortality differentials are not assumed to narrow over time. Treatment requires both access to health services and willingness to pay or take action on the illness. In a depressed economy, the effects may be to reduce health services funding which results in differential treatment. The way in which private and public health services are used has prompted countries such as China to expand public services and to try to put a cap on costs of private care. Cleland's analysis is useful for understanding compositional change and social differentials in mortality during the 1970s and 1980s. Cleland's conclusions are, however, considered "tentative and speculative." Crook suggests a plausible conclusion and asks for comment.