source: World Bank.
At first glance, it seems strange that rich, peaceful countries can have higher CDRs than poor, war-stricken countries. The reason is that although the CDR can be influenced by obvious factors such as war and violence, hunger and malnutrition, and disease and lack of adequate health care, another factor has an even greater impact on the CDR: the age structure of the population. When a baby boom is followed years later by low birth rates, the proportion of elderly in a society increases. For example, many people were born in Europe after World War II ended in 1945. By 2015, that large group was reaching seventy years of age. But younger generations had low fertility rates, which declined through the 1960s, 1970s, and 1980s, meaning there were fewer children. With a large number of elderly and few children in a country, the proportion of elderly is higher. Since the elderly die at a higher rate than the young, the CDR is high (figure 2.15). In contrast, countries with high birth rates, such as Iraq, have a growing number of young people in relation to the number of elderly people. Since the young die at lower rates than the old, these countries can have a low CDR (figure 2.16).
Another measure of mortality is the infant mortality rate, which is a measure of the death rate of infants from birth through their first year per 1,000 live births. This rate has come down significantly over time but still varies considerably (figure 2.17). The highest rate in 2015 was in Afghanistan, at 115. That tells us that 11.5 percent of all children born in Afghanistan die before their first birthday, an astonishingly high number. At the low end is Monaco, with a rate of 1.82 per 1,000, or 0.182 percent. The United States has a rate of 5.87 (0.587 percent), which is higher than many other developed countries.
Figure 2.14.The crude death rate in Europe, North Africa, and the Middle East, 2015. Unexpectedly to many, much of affluent Europe has higher CDRs than poorer and politically unstable countries in the Middle East and North Africa. This disparity relates to the differing age structure of the populations in each country. Explore this map at http://arcg.is/2kUSGcj. Data source: World Bank.
Figure 2.15.Dusseldorf, Germany. Countries such as Germany with a large number of elderly and a smaller number of young people have a higher crude death rate. Photo by Isarescheewin. Stock photo ID: 477151594. Shutterstock.
Figure 2.16.Kirkuk, Iraq. Countries such as Iraq with a large number of children and a smaller number of elderly have a lower crude death rate. Photo by Serkan Senturk. Stock photo ID: 509928916. Shutterstock.
Declines in infant mortality are among the most important achievements in global health in recent decades. In 1960, there were roughly 122 deaths per 1,000 live births, meaning that over 12 percent of all babies died within their first year of life. Continuous declines led to a rate of under 32 by 2015, a decrease of about 73 percent. Economic development has given more people access to clean water, formal health-care systems, sanitation, and adequate nutrition. Thus, mothers and infants are less likely to get sick, but when they do, they are more likely to have access to medical care. For example, oral rehydration therapy, a liquid mixture of glucose and electrolytes, is a simple cure for dehydration, one of the leading killers of infants.
Education, especially for women, has also helped reduce infant mortality rates (figure 2.18). Educated women are more likely to know how to access and navigate public health systems to obtain health care for themselves and their babies. They are also more likely to have a better understanding of nutrition and sanitation to properly feed their children and avoid waterborne and foodborne contaminants. Additionally, educated women are more likely to work and therefore have fewer children, leaving more resources for a smaller number of children.
Figure 2.17.Infant mortality rate, 2015. Explore this map at http://arcg.is/2mg6FKf. Data source: World Bank.
Figure 2.18.Schoolgirls in Skardu, Pakistan. Educating women is an important strategy for reducing infant mortality rates. Photo by Khlong Wang Chao. Stock photo ID: 426040138. Shutterstock.
Afghanistan, which consistently has among the highest infant mortality rates in the world, illustrates how low levels of economic development and low levels of education for women contributes to a high rate of infant deaths. Most babies are born with midwives at home rather than in medical clinics that can more quickly and safely deal with complications. Poverty and high levels of malnutrition mean that many pregnant women give birth to low-weight babies, increasing their babies’ susceptibility to disease. When babies do get sick, medical care is often lacking, so common infections, respiratory illnesses, and diarrhea frequently lead to death. Lack of education, with its corresponding lack of knowledge about health and nutrition, further contributes to a high infant mortality rate. Only about 50 percent of babies under six months of age are exclusively breast-fed. Instead, mothers often feed their babies tea and biscuits, leading to an increased risk of consuming contaminated food or water in a country with limited potable water and inadequate food storage systems.
The United States also offers a good case study on infant mortality. Although the infant mortality rate in the US is low by global standards, it is significantly higher than in other affluent countries (figure 2.19). For instance, a baby born in the US is 2.8 times more likely to die than a baby in Japan. The explanation for this difference is not clearly understood, but what is known is that more babies are born prematurely in the US than in the countries with lower infant mortality rates. Premature birth, which is associated with cigarette smoking, drinking alcohol during pregnancy, diabetes, and high blood pressure, puts infants at greater risk of mortality. This accounts for some, but not all, of the mortality difference. It is possible that the fragmented health care that some young women receive, especially those of lower incomes, prevents clinicians from detecting and monitoring risk factors.
Figure 2.19.Infant mortality rates lower than the United States’ rate. Data source: World Bank.
Life expectancy is the average number of years a person is expected to live. As with all demographic variables we have seen so far in this chapter, life expectancy varies widely around the world (figure 2.20). At the high end in 2015 was Monaco, at 89.52 years, and at the low end was Chad at 49.81 years. The United States has a life expectancy of 79.68 years.
Life expectancy figures can sometimes paint a misleading picture. For instance, life expectancy in the Ancient Roman Empire was 22 years. More recently, Chad had a 2015 life expectancy of 49.81 years. One may get the impression that Ancient Rome had few people beyond their mid-20s, while Chad has few over 50. This is not true, however, since life expectancy is calculated as an average of the age of death of all people in a year. If a country has a high infant mortality rate, those infant deaths pull down the average. Just imagine a place where five people died in the same year at the ages of 1, 19, 56, 79, and 95. The life expectancy for this group would be (1 + 19 + 56 + 79 + 95)/5 = 50. In this case, three people out of five lived beyond the average of 50 years, with one well beyond. What pulls down the average very quickly is when there are many 1s in the equation from infant deaths. Typically, there is a strong spatial relationship between high rates of infant mortality and low life expectancies. Note the similarities between the two in figures 2.17 and 2.20.
Life expectancy has a strong spatial relationship with socioeconomic and lifestyle variables. As with infant mortality, places with stronger economies are more likely
