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deaton_mortality - Journal of Economic Perspectives-Volume...

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The Determinants of Mortality David Cutler, Angus Deaton and Adriana Lleras-Muney T he pleasures of life are worth nothing if one is not alive to experience them. Through the twentieth century in the United States and other high-income countries, growth in real incomes was accompanied by a historically unprecedented decline in mortality rates that caused life expectancy at birth to grow by nearly 30 years. The value of reductions in mortality risk can be roughly estimated from (admittedly heroic extrapolations of) differential wages in the labor market corre- sponding to differentials in the risk of death across occupations. Applying this methodology, Nordhaus (2002, p. 35) has calculated that “to a first approximation, the economic value of increases in longevity in the last hundred years is about as large as the value of measured growth in nonhealth goods and services.” Falling mortality has also usually meant better health for the living, so that people are also living better, healthier, and longer lives than did their forebears. Murphy and Topel (2005), who measure both the value of mortality decline and the benefits of better health for the living, estimate that, between 1970 and 2000, the annual value of increased longevity was about half of conventionally measured national income. Improvements in life expectancy in the United States have been matched by similar improvements in other rich countries. Indeed, there has been a rapid y David Cutler is Otto Eckstein Professor of Applied Economics, Harvard University, Cam- bridge, Massachusetts, Angus Deaton is Dwight D. Eisenhower Professor of International Affairs at the Woodrow Wilson School of Public and International Affairs and Professor of Economics and International Affairs, both at Princeton University, Princeton, New Jersey. Adriana Lleras-Muney is Assistant Professor of Economics and Public Policy, Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey. Cutler and Deaton are Research Associates and Lleras-Muney is a Faculty Research Fellow at the National Bureau of Economic Research, Cambridge, Massachusetts. Journal of Economic Perspectives—Volume 20, Number 3—Summer 2006—Pages 97–120
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convergence of older adult mortality rates since 1970 in rich countries, particularly among men (Deaton, 2004, Figure 7). Outside of the rich countries, average health is strongly correlated with income. As shown in Figure 1, the current version of a graph first drawn by Preston (1975) in which countries are represented by circles and the size of the circle is proportional to population, life-expectancy is pro- foundly lower for countries with lower levels of per capita income. In the years just after World War II, life expectancy gaps between countries were falling across the world. Poor countries enjoyed rapid increases in life- expectancy in the 1950s, 1960s and 1970s, with the gains in some cases exceeding an additional year of life expectancy per year. The HIV/AIDS epidemic and the transition in Russia and eastern Europe have changed that situation. The best
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