Until recently material factors had usually been regarded as the most important forces behind the great mortality decline in Western Europe during the last two centuries. Today, the discussion among historical demographers is much more diversified. Greater consideration is given to other factors than was previously. Predominant in several recent summaries is the argument that there was not one single cause of the mortality decline everywhere and in every age group (Brändstrom 1993; Health Transition Review 1991: 1-2; Mercer 1990; Schofield, et al., 1991; Sundin 1992a). One factor which has gained recognition especially in urban areas is the efforts by local and national agencies to improve hygienic conditions (Riley 1987). Cultural determinants of health have also received increased attention both in articles and monographs, especially in relation to mortality among infants and children (Johansson 1991; Preston and Haines 1991).
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