Resumen

Esta comunicación presenta una breve revisión de los servicios de salud en Estados Unidos durante los años 1850–1960, analiza las tendencias de la mortalidad en base a nueve informes para todos los grupos de edades que han sido publicados por el Centro Nacional de Estadísticas de la Salud durante 1964–68, y compara los resultados con recientes tendencias en Inglaterra y Gales, Chile y Japon.

Una visión general de los análisis y de la presente situacion sanitaria nos permite hacer tres principales observaciones. Primero, las reducciones en la mortalidad infantil desde 1965 permiten alimentar esperanzas de aun mayores reducciones, pero solo investigaciones adicionales pueden confirmar el hecho de que ellas son el resultado del control sobre las condiciones de enfermedad y por lo tanto representan una prediccion de una todavía menor tasa de mortalidad infantil para el futuro. Segundo, las enfermedades crónicas han reemplazado a las enfermedades infecciosas como la causa principal de las muertes naturales. Por lo tanto, adicionales reducciones en las enfermedades infecciosas pueden tener solo un pequeño efecto en la mortalidad total. Además desde que la muerte por razones de enfermedades crónicas ha sido también pospuesta hasta edades más avanzadas, el grupo de edades màs avanzadas ha acumulado proporciones crecientes de personas fisicamente dañadas, y este representa un efecto negativo en las tendencias de mortalidad. No hay razon por lo tanto para esperar mejoras en esas tendencias. Tercero, las muertes violentas han sobrepasado a las muertes por causas naturales como principal causa de muerte durante las edades medias. Mientras medidas de seguridad han reducido las tasas de accidentes en el hogar, el trabajo y los lugares públicos en cambio los accidentes de automobil, el suicido y el homicidio no muestran tendencia a declinar. Esto se debe a que el control público del diseño de los vehículos, construcción de caminos, y educación de conductores se va inponiendo lentamente, y la salud publica tiene muy poco efecto sobre el suicidio y el homicidio que son problemas sociales.

Finalmente, los efectos del progreso siguen siendo mayores para las mjueres que para los hombres; tasas diferenciales de mortalidad por residencia, color y clase social van a ser cada vez más pequeñas, y las tendencias descendentes de las tasas de mortalidad van a ser mas influenciades por los individuos que por la comunidad en el futuro.

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Summary

This report presents a brief review of health services in the United States during the years 1850–1968, analyzes trends in mortality on the basis of eleven reports that have been published by the National Center for Health Statistics during 1964–68, and compares the results with recent trends in England and Wales, Chile, and Japan.

An overview of the analysis and of the current health situation permits three major observations. First, reductions in infant mortality since 1965 are encouraging, but only further research can confirm that they are the result of control of morbidity conditions and thus indicative of still lower infant mortality rates to come. Second, chronic diseases have come to replace infectious diseases as the principal causes of natural death. Further reductions in infectious diseases can have only a very small effect on total mortality. Now, since improved mortality from a chronic condition often means that death from that condition has been postponed to a later age, the older age groups appear to be accumulating increasing proportions of physically impaired lives, and this means an adverse effect on mortality trends. There is no reason, then, to expect improvement in these trends at the very high ages. Third, violent deaths out-rank natural deaths as causes of death before mid-life. While safety measures have reduced accident death rates at home, at work, and in public places, automobile accidents and suicide and homicide will not show decline soon. This is because control of the automobile hazard, which involves motor vehicle design, road construction, and driver education will come slowly. Public health measures for the control of suicide are also slow in development; both suicide and homicide are essentially social problems.

Finally, rates of improvement remain greater for females than for males; differentials in mortality by residence, color, and social class will become even smaller; and mortality trends will be influenced increasingly by individual efforts in the future.

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References

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National Center for Health Statistics, Series 3: No.1,The Change in Mortality Trend in the United States, by I. M. Moriyama (March, 1964); No. 2,Recent Mortality Trends in Chile, by Hugo Behmet al. (April, 1964); No. 3,Changes in Mortality Trends in England and Wales, 1931–1961, by Hubert Campbell (November, 1965); No. 4Infant and Perinatal Mortality in the United States, by S. Shapiro et al. (October, 1965); No. 5,Infant and Perinatal Mortality in Scotland, by C. A. Douglas (November, 1966); No. 6,International Comparison of Perinatal and Infant Mortality, H. C. Chase (March, 1967); No. 8,Infant Mortality Problems in Norway, by J. E. Backer and O. Aagenaes (October, 1967); No. 9,Infant and Perinatal Mortality in Denmark, by P. C. Matthiesenet al. (November, 1967); No. 10,Recent Retardation of Mortality Trends in Japan, by T. Sodaet al. (June 1968); No. 11,Infant Loss in the Netherlands by J. H. de Haas-Posthuma and J. H. de Haas (August, 1968). See also Series 4, No. 3,Report of the International Conference on the Perinatal and Infant Mortality Problem of the United States (June, 1966); Series 20, No. 1,Infant Mortality Trends: United States and Each State, 1930–1964 (November, 1965); and Series 20, No. 2,Mortality Trends in the United States, 1954–1963, by A. J. Klebba (June, 1966). Also pertinent are the discussions by I. M. Moriyama and M. Spiegelman on “Mortality Trends and Projections,”Transactions of the Society of Actuaries, XIX (October, 1967), D440–69.
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