Historical trends of mortality and its implications for health policies in England and Wales: the cause-of-death approach

Historical trends of mortality and its implications for health policies in England and Wales: the cause-of-death approach Mariachiara Di Cesare and Michael Murphy 1. INTRODUCTION Developed countries have experienced a substantial increase in life expectancy in the last century due to lower levels of mortality including a shift from dying at younger ages to older ages (Janssen and Kunst, 2004). This shift has been both a cause and a consequence of a changing pattern in causes of death from communicable diseases to chronic and degenerative diseases (Omran, 1971, 1998; Charlton and Murphy, 1997). The increasing importance of overall and cause-specific mortality patterns, especially among older people, has gained interest especially for the impact – in terms of costs, policies and actions – on the health and social care system (WHO, 2008). Acute care costs for the last year(s) of life (which account for a major part of lifetime health expenditures; see Chapter 13) differ according to the cause of death, reflecting earlier patterns of morbidity (Polder et al., 2006; Pierce and Denison, 2010; Scitovsky 1984, 1994). For example, causes such as unexpected, fatal heart attacks have low costs compared to cancers. Analysis of cause-of-death trends can indicate the interaction of health, economic and social factors with technology and medical knowledge to monitor the present and suggest appropriate policies for the future. Health policies based on use of cause-specific mortality data have to rely on data mainly from death certification for continuous monitoring of mortality over time. Nowadays, most developed..