Response: On 'The Changing Relation between Mortality and Level of Economic Development'

Abstract

I am honoured that my 1975 article1 was thought worthy of reprinting and delighted that my own longevity curve has shifted far enough to allow me to respond to commentators. They have done an excellent job of placing the article in the context of previous and subsequent work and pointing out its strengths and weaknesses. Inevitably, the article is to compared to the work of Thomas McKeown. Although my article and the book that included it2 were published at about the same time as McKeown's volume,3 McKeown's thesis was already well-known through the pages of Population Studies, the same journal in which my article was published. I was therefore able to become an early critic of his work. Nevertheless, the works have much in common. As noted by Kunitz,4 they both used process-of-elimination reasoning to argue that a major factor that had been thought responsible for a large fraction of improvements in mortality was not, in fact, influential. The focus was on what was eliminated, rather than on what remained. Ironically, what was eliminated was a core variable in our own disciplines: medical technology in the case of McKeown, a physician and epidemiologist; and per capita income for someone trained as an economist/demographer. I believe that both volleys hit their primary targets, but it should be stressed that the targets were spatially and temporally limited: England and Wales 1840–1970 in the case of McKeown, and an international collection of populations between 1905 and 1965 in my case.

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