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The Reversal Of Fortunes: World Health Organization

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Describe about The Reversal of Fortunes for Trends in County Mortality and Cross-County Mortality?



The mortality rate as well as the rate of chronic diseases are rising faster in developed countries like United States. This increment in the occurrence of chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD), Lung Cancer and Diabetes has for the most part offsetted the descending mortality trends in United States. It has been estimated that chronic diseases will account for almost three-quarters of all deaths worldwide by 2020. The major cause behind the increase in the occurrence of chronic diseases is linked mainly to the biological, behavioral and societal factors. Biological factors include the examples like dyslipidemia, overweight, hypertension and hyperinsulinemia. Behavioral factors include sedentry lifestyle, use of tobacco and high-fat or animal-based energy dense diets and these factors may act as proximal influences on increased mortality rates. Societal factors, on the other hand, may act as distal influences on mortality rates and include socio-economic, cultural and other environmental parameters.

However, it is important to note that most of the infectious diseases can be controlled with the improvements in sanitation, hygiene, health care and discovery of novel antibiotics. But, still the lifestyle-related diseases are on the rise.3 Behavior has a noteworthy effect on lifestyle-related ailments. Like for instance, the death rates because of coronary diseases has declined drastically from 1970’s to 1995 in Finland where dietary intake and eating routine was principally in charge for this change and treatment as well as medication assumed just a negligible part.


A large portion of high-risk behavioral practices are found in the lower financial and socio-economic classes of the society and general public. Various studies demonstrate a relationship between health and income.3 The poorest areas of the populace are the most helpless. There is an increased incidence of chronic diseases and absence of access to treatment also. In comparison with other segments of the society, the poor people likewise show lower rates of acceptance of health promoting behaviors. The poor are the most at danger, and they have the least power to make an improvement. Therefore, significant approaches need to be adopted and suitable policies need to be formulated in order to support the poor people and reduce the income incongruities. Women constitute another vulnerable group and showed an increase in chronic illness.1 Women for the most of the part had worked as full-time workers earlier. By 1900’s, women began looking for full time outside occupations and also joined the workforce. Fulfilling duties such as bearing and raising a child as well as doing household chores add stress and are an extra burden or weight on women. Women also do not get any assistance from their spouse’s very often. So in the end, women are barely left with any time and vitality to devote towards their health and well-being. Thus, inclusion of family members and social support can assume a noteworthy part in such a circumstance.

In addition to societal and lifestyle components, the medicinal services framework as well as the health care system additionally has a distal impact. The US health system is propelled in therapeutic consideration and well-being. However, the Health Maintenance Organizations (HMOs) acts as a standard of care in US as it focus more on disease and injury and not solely on prevention. Another characteristic feature of HMOs is that the patient’s receive least expensive diagnostic tools as opposed to the best or most suitable ones. Doctors are obliged to treat patients and release them as soon, and affordably as could be expected under the circumstances. However, such practices could lead to missed or late diagnosis as well as lack of time to educate the patients on prevention of disease.

 There is an immense need for the development of a comprehensive intervention plan. The Public health system framework needs to be developed so as to overcome some of the shortcomings. Diverting more funds in the area of disease screening, dental health, health awareness and preventive measures might help. Such policies need to be formulated that focus on effective food labeling, healthy school lunches, widespread nutrition literacy, safer neighborhoods as well as more opportunities for biking, walking and outdoor activities need to be provided. The food industry also plays an important role and should focus on production and marketing of healthier products. Special programs like tobacco and drugs cessation programs as well as the food stamps programs modeled on the same lines as Women, Infants and Children (WIC) program should be introduced to the general public.

The above interventions are based on the theory of planned behavior. The attitude towards behavior, subjective norms and perceived behavioral control are the three main constructs of Translational Behavioral Medicine (TBM) and contributes to behavioral intention. An illustration is of a man who has an ideal mentality towards expending a sound eating regimen. He also regards the consumption of healthy foods to be decidedly seen by his critical others. Moreover, he feels as though he is in control of healthy foods consumption and will probably consume a healthy diet. On the other hand, if that individual needs access to healthy foods which are unavailable to him, then he doesn't have genuine behavioral control over healthy diet consumption. So also, the theory of planned action can be effectively applied to diverse practices including smoking and exercise and sexual conduct.



Ezzati M, Friedman AB, Kulkarni SC, Murray CJL. The Reversal of Fortunes: Trends in County Mortality and Cross-County Mortality Disparities in the United States. PLoS Medicine. 2008; 5(4): e66.

The world health report 1998. . Geneva, World Health Organization, 1998.

World Health Organization. Nutrition: Background: The Global Burden of Chronic. Website April 3, 2015.

Puska P, et al. Changes in premature deaths in Finland: successful long-term prevention of cardiovascular diseases. Bulletin of the World Health Organization, 1998; 76:419-425.

Diclemente RJ, Salazar LF, Crosby R.A. Burlington, MA: Jones & Bartlett Learning; 2013.


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