Routes to Low Mortality in Poor Countries, Revisited

Randall Kuhn, University of Denver

In 1986, Population and Development Review published an influential paper by John Caldwell entitled “Routes to Low Mortality in Poor Countries”. Caldwell explored social and political pathways to mortality success on the basis of two lists of exceptional mortality achievers, countries whose mortality rankings drastically differed from their income rankings. This paper charts subsequent outcomes for Caldwell's original exceptional achievers and develops a modern list of achievers. Analysis highlights the presence of many more poor achievers today; the rising importance of adult mortality as a marker of exceptional achievement; the increasing success of countries in Latin America and the Muslim world; and the continued success of China, Vietnam, Cuba, and Costa Rica. Dramatic improvements in schooling outcomes have reduced its importance as a determinant of superior achievement. Reinforcing Caldwell's original assertions, I suggest that interactions between social consensus, health systems, and human capital dependence offer a pathway to mortality success.