The Risk of Being Sick: Morbidity Trends in Four Countries

Abstract

THE REDUCTION OF DEATH RATES in the developed countries, a trend that has been underway typically for more than a century, is one of the most substantial achievements of humankind. As a result of this revolutionary change in the risk of death, the average number of years that people live has more than doubled. Many observers believe that the mortality decline signals a proportional long-run improvement in health. But the health surveys conducted in a number of countries in recent years suggest that health has failed to improve or has actually deteriorated. When questioned about their health, respondents report larger numbers of health problems, and rising proportions of people identify maladies, especially chronic maladies, and report that their ordinary activities are curtailed by health problems. This article will review evidence about recent trends in mortality and sickness in four countries.' Three of these, Japan, the United States, and Britain, are developed countries where the trend of declining death rates is of long duration, and where health surveys have been conducted regularly for a number of years.2 In the fourth, Hungary, after a steady downward trend since about 1880, death rates have increased since the mid-1960s. There, health has been surveyed in a series of periodic investigations of which two, the surveys of 1981 and 1986, provide information that can be compared on the same terms. Previous discussions of the health trend have focused on an attempt to choose between competing views, one of which is usually called optimistic and the other pessimistic. The optimistic view holds that ill health rates are decreasing, while the pessimistic view holds that ill health rates are increasing. Whereas most measures of sickness incidence indicate that age-specific rates of new episodes have remained stable or decreased, most measures of sickness prevalence or of the average duration of sickness indicate that rates have

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