Mortality and Morbidity in Modern Wars, I: Civil Populations

Abstract

In this chapter, we examine the time trends that have occurred in the causes of morbidity and mortality in civil populations over the last century and a half. Particular attention is paid to the period since 1900 when international comparative data become readily available. We begin with two case studies—of Australia, and England and Wales—to establish the main trends affecting the advanced economies over this period. Next, using data collected by Alderson (1981), we extend our analysis to 31 countries to give global coverage. We look first at the statistical evidence of change. It is shown that mortality and morbidity from all causes have declined. Since 1850, it is the infectious diseases which have witnessed the most spectacular falls in their contribution to total mortality and morbidity. Within the general decline, however, sharp upturns in both mortality and morbidity from infectious diseases occur during times of war. In the second half of the chapter, we examine some of the factors which lie behind the declines. Notwithstanding the general falls, in recent years there has been a revolution of interest in infectious diseases arising from a sharp resurgence of both old and new diseases. The former include drug-resistant strains of tuberculosis and the latter HIV (human immunodeficiency virus). The disease setting is also evolving with environmental change and increased human interaction. And so the chapter is concluded with an assessment of the potential significance of infectious diseases in the present century in times of peace and war. In Australia, notifiable diseases data are collected by states and territories under their public health legislation; collection has taken place on a regular basis since 1917. The legislation has required medical practitioners and some other classes of people to notify health authorities of the number of cases recorded of certain communicable and other diseases. The resulting data were published in the Medical Journal of Australia from 1917 to 1922, Health, 1924 to 1939, and in the Commonwealth Year Book since 1945. Additionally, the Commonwealth Department of Health and its successors have published an annual compilation of notifiable diseases data in the Department’s Annual Report.