Adult mortality in developing countries

For the past decade, the international health community has focused on the burden of childhood mortality and morbidity in developing countries. As a consequence, there has been little comprehensive, as contrasted with disease-specific, interest in the health problems of adults. Underlying this lack of attention is the widespread belief that once a person reaches adulthood, there is little difference in mortality experience between developing and industrialized countries. Some would probably go so far as to suggest that adult mortality should be lower in some developing countries because of the rarity of certain ‘western’ risk factors for chronic diseases. The reality is different: adult mortality, as well as child mortality, is much higher in developing than in industrialized countries and represents an important target for development policy and intervention. Adults may be defined with reference to the roles that they play in society. They are the parents, the workers, and the leaders in all communities. Adults are also the providers and care-givers for children and the elderly. A functional definition of adulthood, while appealing, is not well suited to quantitative analysis. We have, therefore, defined adulthood as the population aged 15 to 59 years. This definition is consistent with the United Nations defmition of the ‘aged’, which includes the population over age 60. The age-span 15 to 59 includes those age-groups in which, in industrialized countries, we expect mortality to remain quite low. For most of us, deaths before age 60 are premature and should be prevented. With this definition of adulthood, 56% of the developing world’s population are adults; they number a httle over 2x 10 ; and 32% of them live in China. According to World Bank estimates, in the developing world as a whole, 38% of deaths occur in children aged ti years, while 27% occur in adults (15-59). To adjust for the expected age-distribution of deaths in a low mortality country, we can calculate avoidable deaths. These are deaths that would not occur if the mortality rates of a specified low mortality reference population applied to developing countries. Japanese death rates in 1987 have been used as a reference-Japan has the highest life expectancy in the world. According to these computations, there are 8 million avoidable adult deaths each year in the