Epidemiology: The Influence of Socioeconomic Differences

  • Gabriele Halwachs-BaumannEmail author


In the last 150 years, infant mortality decreased continuously. In the middle of the nineteenth century, infant mortality rate was about 160 per 1000 live births in England with remarkable differences between largely agricultural counties (rate 110) and largely industrial counties (rate 163). This rate declined until the middle of the twentieth century to a rate of about 20–30/1000 live births [1]. The same situation was shown for other European regions and the United States [2, 3]. Leading causes of death were atrophy, debility, and marasmus, followed by diarrhea and enteritis and, on the third place, bronchitis and pneumonia. The association of infant mortality with poverty and bad housing was evident [1, 3]. This situation has not changed, as shown in the World Health Statistics 2009. Globally, an estimated 37% of deaths among children under 5 occur in the first month of life, most in the first week. Countries making the least progress are generally those affected by high levels of HIV/AIDS, economic hardship, or conflict. The disease incidence could be reduced by improved water and sanitation supply. However, because the availability and use of proven interventions at community levels remain low, pneumonia and diarrhea still kill 3.8 million children under 5 each year [4]. Studies analyzing infant mortality in the Americas showed a continuous reduction of infant mortality from 90.34 per 1000 live birth in 1955 to 31.31 in 1995, that is, a reduction of 65%. Not all of the countries of the region presented the same reduction. Paraguay, Guyana, Bolivia, and Haiti showed a decrease of 41–60%, while most of the countries (among others the United States) presented a reduction between 61–80%. A number of ten countries showed a decrease of more than 80%, with the highest percentage of reduction in Cuba (87.65%), Chile (88.33%), and Barbados (93.18%). One of the findings of this study is that social inequalities and inequality in health, two facts closely connected, persist in countries of the American Region. Government health expenditures in several countries are usually more beneficial for those better off than for the poor, although political will combined with effective public policies could move the focus of the expenditures of governments toward the poor (shown in Cuba, Chile, and Barbados), thus reducing infant mortality rate as indicator of the health conditions of the population [5].


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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Laboratory MedicineRegional Hospital SteyrSteyrAustria

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