Thursday, January 5, 2012

Chapter 2. Global post-1950 excess mortality and under-5 infant mortality

Chapter 2. Global post-1950 excess mortality and under-5 infant mortality

“A single death is a tragedy, a million deaths is a statistic.”

Joseph Stalin 1

“We are responsible not only for what we do but also for what we could have prevented… We should consider the consequences both of what we do and what we decide not to do.”

Peter Singer in Writings on an Ethical Life 2

“Thou shalt not kill.”

Ten Commandments of the Holy Bible, Exodus, 20:13 3

“Everyone has the right to life, liberty and security of person.”

Article 3, UN Universal Declaration of Human Rights 4

We hold these truths to be self-evident, that all Men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

Thomas Jefferson, The American Declaration of Independence 5

2.1 Estimation of mortality and avoidable mortality (excess mortality)

Excess mortality for a given country for a given period is the difference between the ACTUAL mortality and the deaths EXPECTED for a decently run, peaceful country with the same demographics. The problem of assessing such “ideal”, EXPECTED mortality rates has been approached here in an empirical, interpolative fashion. The United Nations Populations Division has provided detailed demographic data of population, crude birth rate and crude death rate for the period from 1950 onwards for essentially all countries in the world together with projections for beyond 2005. This enables simple calculation of mortality for all countries in the world for the period 1950-2005 (or, precisely, from mid-1950 to mid-2005) . This detailed demographic data has also been used graphically to assess baseline “ideal” mortality rates for all countries to enable calculation of “excess mortality” over the period since 1950 as described below.

Typically, since 1950 the observed crude death rate for a “good” country starts out at a relatively very high value, progressively declines to a minimum value and then starts increasing slightly, this latter effect reflecting an increasingly older population. However there are a number of variations on this theme:

a. In the case of the Netherlands the mortality rate did not decrease since 1950 and in fact has steadily increased, albeit very slightly. This situation formally yields an excess mortality estimate of zero over this period.

b. A more typical result for “good” countries (notably most Western European countries but with numerous examples in the non-European world) involves a slight decrease in the death rate to a minimum value, this being followed by a very small but steady increase reflecting an increasingly aged population (in an ideal situation only the elderly would die) . This minimum value has been taken as a “baseline” estimate of “ideal” mortality rate for the preceding period, excess mortality being taken as zero for the period after this minimum was achieved.

c. With some European countries, notably many in Eastern Europe (and Hungary in particular), the death rate from the 1960s onwards has been slightly but distinctly higher than that obtained in Western European countries. The causes of this small elevation in death rate are not clear (although smoking, excess alcohol consumption and socio-medical factors linked to authoritarian communist régimes can be speculatively invoked). This post-minimum “extra” mortality rate has been taken into account for these countries.

d. For “good” non-European countries with an initially high but subsequently declining birth rate (notably in East Asia and in many countries of South East Asia, South America, the Pacific and the Arab Persian Gulf), the values for the minimum post-1950 baseline annual mortality rate cluster around 4 per 1,000 of population. This has been taken as the “baseline” mortality rate value for a swathe of initially high birth rate countries in Africa, Asia, South America and the Pacific in which the mortality rate has not reached a minimum since 1950. It has also been used as a baseline for a swathe of countries in Africa in which the birth rate has remained very high, this being a conservative assumption that will actually underestimate the excess mortality because ideally mortality rate should be very low in countries with a very young population.

This empirical, interpolative approach has been applied to virtually all countries in the world (with the omission of some tiny states such as Andorra, Monaco, Liechtenstein and some island states of the Caribbean and Pacific). The total excess mortalities since 1950 were then calculated for all countries by simple addition. This then enabled calculation of the post-1950 excess mortalities for specific, geopolitically defined regions and the total excess mortality for the whole world.

No doubt much more exacting analyses can be performed using highly-tuned mathematical modelling employing baseline mortality estimates responding exquisitely to subtle changes in demographic patterns. Nevertheless, as outlined in the Introductory Chapter, my approach was dictated by resources, acceptable simplicity and the urgent need to get a reasonable figure before an unheeding and unresponsive world in order to minimize the carnage. Further, the quantitative validity of the present approach has been checked by applying a completely different approach, namely that of estimating post-1950 under-5 infant mortality.

In an ideal world, death would overwhelmingly involve the elderly. However in reality most “excess mortality” occurs in relatively high birth rate non-European countries with children being the major victims of avoidable death. Thus the total post-1950 excess mortality of the world is 1,302 million with 55 million (4.2%) of this deriving from relatively low birth rate European countries. In comparison, the total post-1950 under-5 infant mortality is 878 million of which 25 million (2.8%) derives from European countries. The under-5 infant mortality total is thus clearly consonant with the total excess mortality estimate. The calculation of under-5 infant mortality is outlined below.

2.2 Calculation of under-5 infant mortality

The United Nations Children’s Fund (UNICEF) provides detailed statistics on under-5 infant mortality rates (annual under-5 year old deaths per 1,000 live births) for virtually all countries in the world since 1960. Under-5 mortality rates were plotted versus time; rates in the short intervals of 1950-1960 and 2002-2005 were obtained elsewhere or by extrapolation and rates between the major period of 1960-2005 by interpolation. In some cases (notably for several Pacific, Caribbean, African and Central Asian countries), estimates of under-5 infant mortality at particular times were obtained from data for demographically similar countries within the same geopolitical grouping.

The United Nations Population Division provides population and crude birth rate data back to 1950. Using this data, live births were calculated for all countries over this period. Using under-5 infant mortality rates per 1,000 live births, the under-5 infant mortality was thence calculated for all countries since 1950. The 2003 estimates of annual under-5 deaths are in agreement with UNICEF calculations (UNICEF, 2005) indicating the validity of the methodology used in this analysis. As indicated above, the total post-1950 under-5 infant mortality of 878 million for the world is consonant with the total global post-1950 excess mortality estimate of 1,302 million. These two parameters are compared further below.

2.3 Comparison of global and regional post-1950 total mortality and under-5 infant mortality

Table 2.1 and the following tables summarize regional and global data for post-1950 excess mortality and post-1950 under-5 infant mortality. In these tables the “post-1950 excess mortality/2005 population ratio” is abbreviated as EM/POP and the “post-1950 under-5 infant mortality/2005 population ratio” is represented as IM/POP.

We are all aware from electronic and print media that mortality, and infant mortality in particular, are “very bad” in the Third World but the actual numerical magnitudes of the total global post-1950 excess mortality (1.3 billion) and under-5 infant mortality (0.9 billion) are utterly appalling. It is accordingly important to examine the validity and consistency of these estimates.

As outlined above, the calculations of total mortality and under-5 infant mortality are straightforward and the 2003 results are in precise agreement with UNICEF calculations.

Thus the total mortality and under-5 infant mortality estimates are essentially unexceptional from a methodological point of view. On the other hand, the excess mortality calculations depend on assumptions of estimated baselines of “ideal” mortality expected for decently-run, peaceful countries with the same demographics. However the values used have involved conservative judgments and the methodology has been applied consistently to obtain estimates of “avoidable mortality” (excess mortality). Of course, the accuracy of the primary UN data could be sensibly questioned but for the present humanitarian exercise it is essentially all that is readily available.

Everyone has to die but the most vulnerable people are the very young and the very old. Thus plots of mortality versus age show marked elevation at either end of the age spectrum. The total mortality in a society will depend upon birth rate, death rate, age distribution and the social parameters influencing these factors. Thus in typically well-run, peaceful and prosperous societies such as those of European countries, children represent a lower proportion of society than in non-European countries, mortality is largely confined to the elderly and infant mortality is a very low proportion of total mortality (Table 2.1). 6

Estimates of total mortality for various geopolitical groupings can be “normalized” for the purposes of comparison, for example by expressing post-1950 mortality as a percentage of the present population (Table 2.1). The values of post-1950 mortality/2005 population range from about 30.6% (Latin America and the Caribbean) to 54.9% (non-Arab Africa), these values reflecting high birth rate/low death rate and high birth rate/high death rate combinations, respectively. However a sharper focus is obtained by examining mortality among specific age groups, such as infants under the age of 5.

Post-1950 under-5 infant mortality as a percentage of total mortality is 3.3-7.2% (European groupings) and 28.6-49.7% (non-European groupings) (Table 2.1). However these quotients depend upon factors influencing the numerator and the denominator - infant mortality will depend upon social conditions affecting the rate of infant mortality and the number of infants; the total mortality will depend upon factors influencing mortality in various age ranges and the proportions within those ranges. Thus in European countries there is a low infant proportion/low infant mortality rate combination but in most non-European countries there is a combination of a higher proportion of infants and high infant mortality. This is dramatized by the under-5 infant mortality/total mortality percentages of 3.3% for Western Europe and 49.7% for non-Arab Africa.

2.4 Estimation of avoidable under-5 infant mortality

From the under-5 infant mortality/total mortality ratios we can already see a marked divide between European and non-European groupings but the ratio per se does not tell us of the underlying contributing parameters of age distribution and age-specific mortality and the social factors giving rise to these. However, expressing post-1950 under-5 infant mortality as a percentage of the present population gets us much closer to an idea of what have been “good” and “bad” societies in terms of infant mortality - this ratio averages 2.2% for European societies, 15.9% for non-European countries and 13.6% for the world as a whole. However such differences must be assessed properly by taking demographic differences into account, specifically the proportion of under-5 year olds in the various groups; such an approach enables estimation of how much of the observed under-5 infant mortality is “avoidable” in relation to an appropriate baseline.

When the post-1950 under-5 mortality/2005 population percentage for every country is tabulated, the 4 best countries are revealed as Iceland (population 0.3 million), Norway (population 4.6 million), Netherlands (population 16.3 million) and Australia (population 20 million), each having a percentage “score” of 1.0%. Australia is ethnically diverse and more populous than the other countries and can accordingly be conveniently used for a baseline to indicate “world’s best practice” in terms of achievement of low under-5 infant mortality over the period 1950-2005.

Assuming that the Australian total post-1950 under-5 infant mortality of 0.202 million is as good as any country could do over this period, we can further assume that this result represents the “unavoidable” under-5 infant mortality for any human population over this period with the same key demographic components, namely an average population of 14.162 million and an average under-5 infant percentage of the population of 8.65%. We can solve for the “intrinsic factor”, F, that yields this result from the following equation:

Australian total post-1950 “unavoidable” under-5 infant mortality = F x 14.162 million x 0.0865 = 0.202 million. The value of F is 0.165. We can now apply this value of F to other situations in the post-1950 period as described below.

Afghanistan had an average post-1950 population of 14.550 million, a total under-5 infant mortality of 11.514 million and an under-5 age group representing an average of 17.75% of the population. Using our factor F from our analysis of the Australian result we can calculate that the Afghanistan total post-1950 “unavoidable” under-5 infant mortality = 0.165 x 14.550 million x 0.1775 = 0.424 million. The “avoidable” infant mortality is thus 11.514 – 0.424 = 11.090 million, this representing 96.3% of the total under-5 infant mortality.

Similar calculations involving UN data of under-5 percentage of population, post-1950 average population, post-1950 under-5 infant mortality and the same F value of 0.165 can be performed for other countries and groups of countries to estimate the “avoidable” under-5 infant mortality. Thus the “avoidable” post-1950 under-5 infant mortality for Iraq represents about 88% of the total for Iraq and that for the whole world represents about 90% of the total for the world.

This analysis indicates that about 90% of the post-1950 under-5 infant mortality in high death rate countries and in the world as a whole has been “avoidable” based on the Australian “world’s best practice” standard as a baseline. Of course for prosperous countries the “avoidable” percentage of the under-5 infant mortality has been much lower e.g. about 20% for the US and, by definition, 0% for Australia.

2.5 Comparison of under-5 infant mortality and excess mortality

Measurements can be made of differences in mortality between countries (differential mortality) but for the purposes of valid comparison the mortality statistics have to be “normalized” e.g. by expressing them as a ratio with respect to the present population or the average population over a given period. We have seen that ratios such as total under-5 infant mortality/present population give pointers to differential mortality in different countries and groups of countries but that such parameters have to be corrected by taking into account the actual proportion of under-5 year olds. Calculation of such corrected and “normalized” “under-5 infant mortalities” (or indeed mortalities in other population segments) for every country in the world for the period from 1950 onwards is possible - but this would be an immense task.

As described in section 2.1, an all-encompassing approach to the problem of calculating differential mortality in the world is to estimate “excess mortality” (avoidable mortality), this being the difference between the ACTUAL mortality for a country in a given period and the mortality EXPECTED for a well-administered, peaceful country with the same demographics. The approach taken here for every country in the world for the period 1950-2005 has been to obtain estimates of what the “base-line” death rate should have been over this period, to then calculate the “excess mortality rate” and hence calculate the excess mortality. This approach takes into account differences in demography between countries and does not confine itself to only one age segment of each population.

More exquisitely massaged estimates of the “excess mortality rate” can be envisaged using sophisticated mathematical modelling and people can legitimately quibble about the methodology employed here. Nevertheless the methodology employed has been reasonable, well-defined and consistently applied. Further, the independently calculated total post-1950 under-5 infant mortality of 878 million is similar to the total excess mortality (1,302 million). However more exacting comparisons can be made as outlined below.

Empirically for the whole world, the total post-1950 infant mortality is 67.4% of the estimated total excess mortality. However it is clear that the world falls into 2 clear-cut sets in relation to total post-1950 under-5 infant mortality - thus the ratio of this parameter to total mortality is 4.8% for the European world and 38.4% for the non-European world and the ratio to current population averages 2.2% for the Europeans and 15.9% for the non-Europeans. The ratio (as a percentage) of total post-1950 under-5 infant mortality to total post-1950 excess mortality is 45.7% for the European countries (value range 34.8-54.8% for regional subsets) and 68.4% for non-European countries (with values ranging from 47.5% to103.3% for the various regional subsets).

It is apparent from the data presented in Tables 2.1-2.12 that there are big differences between countries and regions in the total mortality, under-5 infant mortality and excess mortality when these parameters are “normalized” by expressing these parameters as ratios of each other or as ratios with respect to the current relevant population. It is important to note that while under-5 infant mortality and excess mortality have been calculated by independent approaches, the ratios of these parameters to total mortality and current population all essentially follow a consistent pattern when the various geopolitical regions of the world are ranked.

The calculation here of under-5 infant mortality involves unexceptional and straightforward arithmetic employing UN- and UNICEF-derived statistical data on population, birth rate per 1,000 of population and under-5 infant deaths/per 1,000 births. While the calculation of total mortality is similarly straightforward (simply involving knowledge of population and deaths per 1,000 of population), assessment of excess mortality involves more complicated, interpolative assessments of graphical presentations of mortality versus time, assessments of demographic similarities and estimations of what are “ideal” mortalities for particular countries over time. Nevertheless, excess mortality is a useful parameter in that it provides a measure of avoidable mortality for all subsections of a population.

The consistency in the relative values of post-1950 excess mortality and post-1950 under-5 infant mortality (Tables 2.1-2.12) means that for particular countries and regions we can now very simply estimate excess mortality from unexceptional and straightforward calculations of under-5 infant mortality from UN and UNICEF data.

2.6 “Humanizing” mortality

People inevitably die but ideally were expected do so in past decades after “three score years and ten” (or perhaps “four score years” in more recent years). The values of total post-1950 mortality expressed as a percentage of current population cover a relatively narrow span from 30.6% (relatively poor Latin America and the Caribbean) to 54.9% (for wretchedly poor, high birth rate non-Arab Africa) (Table 2.1). The average values of this parameter are 42.4% (for the world), 46.9% (for the European world) and 41.5% (for the non-European world). The similarity in these values simply reflects the reality that we all have to die and nearly all do so in the time span of the order of a century.

In an “ideal” world, mortality would be largely confined to the elderly and accordingly the post-1950 mortality/2005 population ratio should ideally be much lower for the non-European world which has a much higher proportion of children than European societies - the numerator should be lower (because of the lower mortality of children), the denominator should be higher (because of the relatively higher population growth in high birth rate societies) and accordingly the quotient should be lower. However the very similarity of the average post-1950 mortality/2005 population ratios for the European and non-European groupings and the much higher ratio for non-Arab Africa (54.9%) than for Overseas Europe (35.9%) both tell us that something is seriously wrong in the world, that there is a major departure from the “ideal”.

Fundamental human expectations of “ideal” circumstances colour our attitudes as exampled by the simple statement above that “something is seriously wrong in the world”, that there is a major departure from the “ideal”. Thomas Jefferson in the American Declaration of Independence provided a powerfully succinct statement of fundamental human expectations of the “ideal” in his enunciation of “self-evident” “truths”:

We hold these Truths to be self-evident, that all Men are created equal, that they are endowed by their Creator with certain unalienableRights, that among these are Life, Liberty and the Pursuit of Happiness”.

2.7 “Humanizing” excess mortality

We have all become familiar via the electronic and print mass media with the phenomena of poverty, disease, violence, mass mortality and mass infant mortality in the Third World. However the present analysis aims to quantitate global mortality by estimating the actual numbers involved - and hence instigate more resolute action to stop this immense crime against humanity in a globalized and highly militarized world. Thus we are all aware of the World War 2 Jewish Holocaust and most people are aware that some 6 million people died. The simple idea that “many” or “lots” of Jews died is insufficient - the quantitation of “6 million” really challenges our comprehension of that appalling crime. Further, the figure of “6 million” and its psychological consequences powerfully underscore the Jewish resolution of “Never again”. 7

However the numbers involved in global mass mortality are 2 orders of magnitude greater than the death toll of the Jewish Holocaust. Global post-1950 excess mortality and under-5 infant mortality total 1.3 billion and 0.9 billion, respectively, and about 90% of the non-European under-5 infant mortality of over 0.8 billion has been avoidable. The challenge is to come to grips with these immense numbers in human terms. Some approaches to “humanizing” excess mortality and under-5 infant mortality are outlined below.

Excess mortality can be expressed as a percentage of mortality, thus telling us what proportion of observed mortality has been avoidable. We are familiar with responses to particular kinds of death that have in an absolute or statistical sense been unavoidable. Thus the death of the very old will typically be described as death after “a good innings”. Given that cancer and some other debilitating and painful diseases are major causes of premature death among the middle aged in the West, people might say in retrospect that “it was good that suffering was not too prolonged”. Deaths from accidents, adverse medical circumstances and even from smoking evoke sympathy, especially when the victims are very young or in the prime of life. However passion and anger only emerge when there has been clear-cut human avoidability – as in murder, manslaughter and social or individual negligence.

There is a marked divide in relation to the post-1950 excess mortality/ post-1950 mortality ratio between the European world (average10.6%; range 3.3-26.3%) and the non-European world (average 56.2%; range 8.2-87.0%). The excess mortality (avoidable mortality)/total mortality ratio has been on average over 5 times greater in the non-European world than in European countries i.e. in a risk assessment sense, avoidable mortality has been much more likely for non-Europeans than for Europeans. Overall only 10.6% of mortality has been avoidable in the European world whereas the 56.6% proportion means avoidable death is much more likely than unavoidable death for non-Europeans.

However the excess mortality/mortality ratio still gives us a somewhat depersonalized, statistical view of avoidable mortality. We have some perception of the dangers of some relatively common human pursuits – thus there are 6 billion people in the world and yet each year 1 million (0.017%) die in car accidents and 5 million (0.083%) die from cigarette-smoking-related causes. Nevertheless, in prosperous, risk-conscious European societies nearly everyone will travel by car and perhaps 25% of people smoke. A more personalized estimate of excess mortality is accordingly required.

Expressing post-1950 excess mortality as a percentage of the current (2005) population for given groupings is one way of “humanizing” these mortality statistics. Thus for Australia the excess mortality/present population ratio is 2.9% i.e. about 3 people died avoidably since 1950 for every 100 Australians alive today. Thus at a wedding or another such big gathering of happy people only several guests out of 100 would carry the weight of some tragic, avoidable loss over the preceding half century. Indeed, for my own immediate family in Australia (blood relatives, spouses and offspring), the definitely avoidable post-1950 mortality/current people ratio has been 1/31 i.e. 3.2%.

On the other hand, the post-1950 excess mortality/present population ratio for Timor-Leste (East Timor) is 81.0% i.e. for every 100 people alive in East Timor today, since 1950 there have been 81 avoidable deaths (from deprivation, malnourishment-related disease, lack of primary health care and outright genocidal violence). Again I can offer an “anecdotal” personal experience relating to this appalling statistic. Several years ago we attended a huge wedding reception in Melbourne for a lovely couple who had both been involved in help for East Timorese refugees. We sat at a table with many East Timorese, young and old. The adults spoke very little English but I solved my communication problem by ducking out of the feast, purchasing a ream of A4 paper and some black felt-tipped pens and then drawing rapid portraits of everyone. The children were delighted and happy. The adults were also happy but in the portraiture process I had to look deeply into their eyes – and saw, without exception, pain from their dreadful experiences and loss.

Of course the issue arises of how “avoidable” the estimated “avoidable” mortality has actually been. This analysis covers the period from 1950 onwards during which period the UN has provided the requisite demographic statistics for this study. However the post-1950 period is important for another reason. Since that time potentially everyone in the world could have had access to a whole range of survivability-linked social benefits - including sanitation, clean drinking water, soap, antiseptics, major vaccinations, mosquito netting, antimalarials, antibiotics, universal literacy, preventative health education and primary health care. Indeed the “baselines” used in this study are not the products of space-age 21st century medical miracles but the empirical results actually achieved by demographically similar countries over this post-1950 period.

2.8 The human aspect of under-5 infant mortality

A common fundamental trait of human beings is affection for children. Human offspring are peculiar in their post-partum helplessness and long-term dependence on their mothers and indeed on other members of their social group. The size of the human brain requires birth at a stage permitting safe egress that is then followed by lengthy period of dependence. This lengthy rearing process involves a major social investment that is reflected in maternal love, paternal and sibling affection, the involvement of other family members (notably the “allomothering” or “aunt-behaviour” of women) and the warm regard and conspicuous protection offered by society as a whole. 8

Good treatment of infants is characteristic of orderly human societies but within populous societies under acute stress such decent human behaviours will be discarded. However, even in some conspicuously violent, male-dominated societies there are conventions prohibiting male violence against other men in the presence of women and children. Nevertheless, from child labour in the colonial era and the early days of the industrial revolution to present-day Third World child labour, child soldiers and child prostitution, economic pressure and greed have perverted “natural” human behaviour towards infants.

Historically, mass mortality of infants was associated with the genocidal European invasions of North America, South America, Australasia and the Pacific in which introduced disease was more important than conventional violence in decimating native populations. In the last century explicit, violent mass murder of infants (as well as of adults) occurred repeatedly, as for example during the genocides applied to the Hereros of Namibia, the Armenians of Anatolia, the Jews of Europe, the Cambodian civilian victims of the Khmer Rouge, the Tutsis of Rwanda and the East Timorese victims of Anglo-American-backed Indonesian military.

Whether a child dies a violent death or dies of deprivation or malnourishment-exacerbated disease, the end result is the same. Accordingly, to this list of infanticidal horrors of the last century we should add the victims of enormous man-made famines in Russia (the early 1920s), the Ukraine (early 1930s), British-occupied Bengal (during World War 2) and China (during the Great Leap Forward). Major wars such as the Japanese invasion of China, World War 1 and World War 2 have been major killers of civilians through the accompanying social and economic dislocation. Notwithstanding the creation of the UN after World War 2, there has been immense avoidable infant mortality over the last half century that is closely linked to First World-imposed occupation, neo-colonial “occupation”, economic exploitation, economic exclusion, militarization, debt, corrupt client régimes and war.

For decent human beings like ourselves, the mass abuse and mortality of infants is simply unacceptable. It nevertheless continues unabated – as evidenced by the 0.9 billion post-1950 under-5 infant mortality. One is almost reduced to impotent despair when one sees that the mainstream media of the First World countries with a massive responsibility for this carnage will not even report the magnitude of this holocaust. Politicians when very very rarely cornered on this issue will obfuscate by solely addressing the issue of violence-associated infant death that is very difficult to quantitate (as in war-torn Iraq at the moment) while utterly ignoring the overwhelmingly much more important issue of overall avoidable infant mortality.

Avoidable mortality in non-European countries is regarded by politicians and media as somehow “normal” or “too hard” to deal with – but neither proposition is correct. Avoidable mass infant mortality is utterly abnormal, unacceptable and the outcome of obscene socio-political pathology. Assertions by Europeans that high mortality for non-Europeans is somehow a “normal state” are simply racist and implicitly genocidal. Further, a long list of “good outcome” countries detailed here show that this immense crime can be readily addressed. One way of addressing this evil is to identify the dimensions of the problem and to establish causality. Tables 2.1-2.12 document the extent of excess mortality and under-5 infant mortality for all regions and essentially all countries in the world. Tables 2.2-2.12 also include current data on life expectancy, per capita income and literacy for each country to enable ready correlative assessments.

The “post-1950 excess mortality/2000 population ratio” averages as follows in increasing order for the major groupings: 2.7% (Overseas Europe) < 5.0% (Western Europe) < 7.5% (Eastern Europe) < 9.4% (Latin America and Caribbean) < 10.9% (East Asia) < 20.7% (Turkey, Iran and Central Asia) < 23.0 (Arab Middle East and North Africa) < 25.1 (South East Asia) < 27.3% (the Pacific) < 31.9% (South Asia) < 43.2% (non-Arab Africa). This pattern is substantially reflected in that for the “post-1950 under-5 infant mortality/2005 population ratio”, the order being: 1.5% (Overseas Europe) < 1.7% (Western Europe) < 7.2% (Eastern Europe) < 9.7% (Latin America and Caribbean) < 10.3% (East Asia) < 12.8% (South East Asia) < 13.0% (the Pacific) <15.4% (Arab Middle East and North Africa) < 17.0% (Turkey, Iran and Central Asia) < 19.5% (South Asia) < 27.3% (non-Arab Africa).

In general, post-1950 excess mortality increases with decreasing per capita income but excellent outcomes have been achieved in countries with relatively low annual per capita incomes of about $1,000, namely Cuba, Paraguay and Sri Lanka which have “post-1950 excess mortality/2005 population” ratios of 4.1-9.4% as compared to that of 2.8% for the US (annual per capita income about $38,000). Low excess mortality is associated with high adult literacy but appallingly high post-1950 excess mortality can still occur in countries with adult literacy in excess of 80% e.g. Congo (Brazzaville), Lesotho, Namibia, South Africa, Swaziland and Zimbabwe. However, war and occupation imposed by First World countries generally correlate with excess mortality. The following chapters analyse the dimensions, correlates and causes of the continuing humanitarian disaster of global avoidable mortality.

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