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Research Article

The Reversal of Fortunes: Trends in County Mortality and Cross-County Mortality Disparities in the United States

  • Majid Ezzati mail,

    To whom correspondence should be addressed. E-mail: majid_ezzati@harvard.edu

    Affiliations: Harvard School of Public Health, Boston, Massachusetts, United States of America, Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States of America

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  • Ari B Friedman,

    Affiliation: Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States of America

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  • Sandeep C Kulkarni,

    Affiliations: Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States of America, University of California, San Francisco, California, United States of America

    X
  • Christopher J. L Murray

    Affiliations: Harvard School of Public Health, Boston, Massachusetts, United States of America, Initiative for Global Health, Harvard University, Cambridge, Massachusetts, United States of America, Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America

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  • Published: April 22, 2008
  • DOI: 10.1371/journal.pmed.0050066

Reader Comments (9)

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Author's response to Thompson ("Valley of Death ")

Posted by plosmedicine on 31 Mar 2009 at 00:26 GMT

Author: Majid Ezzati
Position: Associate Professor of International Health
Institution: Harvard School of Public Health, Department of Population and International Health
E-mail: majid_ezzati@harvard.edu
Additional Authors: Ari B Friedman, Sandeep C Kulkarni, Christopher JL Murray
Submitted Date: May 12, 2008
Published Date: May 12, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

We agree with Thompson that mortality and mortality trends are rooted in socioeconomic factors that are related to, and affect, many other aspects of welfare. We also believe that empirical research should investigate such influences. We however find it peculiar that one would consider not having answered what is a distinct research question a shortcoming of an empirical result. Thompson seems to have a different paper in mind and not the current study.

Beyond this, we believe that the importance of socioeconomic factors, including on how health systems function, does not rule out the possibility and the responsibility of targeted interventions that can successfully reduce health disparities. Many experiences in low-income countries - such as those related to insecticide-treated bednets, ARVs, and interventions for child mortality – demonstrate that public health and health care can reduce mortality and mortality disparities parallel to, or in advance of, fundamental social and economic policies. Not to hold the health system in the US to the same standards seems like a low bar. As we strive for better social conditions, which we ought to, we should also keep the public health system accountable for delivering proven effective personal and population level interventions for risk factors such as high blood pressure and tobacco smoking (1-3) to the communities who most need them.

1) Murray CJ, Lauer JA, Hutubessy RC et al. Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk. Lancet 2003; 361(9359):717-725.

2) Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet 2007.

3) Lim SS, Gaziano TA, Gakidou E et al. Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income countries: health effects and costs. Lancet 2007.

Competing interests declared: We are the authors of this paper.