Routes to low mortality in poor countries.

This paper examines how certain populations have achieved low mortality and whether these methods might be utilized by other poor populations. Mortality levels are examined relative to income levels for Third World countries classified as either superior health achievers or poor health achievers; other variables examined are population density family planning use religion and educational level. 3 societies with exceptionally low mortality are Sri Lanka Kerala India) and Costa Rica; these 3 settings are examples of successful "breakthrough" health programs. Similarities among the 3 include a substantial degree of female autonomy dedication to education an open political system a largely civilian society with no rigid class structure and a history of egalitarianism and radicalism. All 3 populations are small; dense settlement and widely diffused commercial farming in rural areas demonstrated in these 3 regions appear to favor reduction in rural-urban mortality levels. Breakthrough periods are identified for each of the societies when provision of health services was implemented on a large scale. In rural areas the primary health center is a base for midwives and health auxiliaries and household visits are an integral part of the program. By substantially raising the proportion of budgetary allocations to education and health (particularly emphasizing education for women) other countries can advance towards low mortality levels. Though the characteristics of the low mortality societies have long historical antecedents effective substitution for this historical experience has been made by some socialist countries and other substitutions are possible in the rest of the Third World. Religion is shown to have been associated with cultures that in some cases have retarded mortality decline and in others assisted it.