James Riley

The Risk of Being Sick

1. General Feature of the Article

Contrary to the idea that the 20th century developed countries have been able to decrease the morbidity rate effectively - extrapolated largely from the declining death rate - in actuality the morbidity rate and the mortality rate in the developed nations seemed to have moved in opposite directions. That is, as mortality rate declined in the 20th century for developed nations, morbidity rate increased, rather than decreased. Riley first looks at the empirical data from four nations, Japan, the United States, Britain, and Hungary, to ascertain that this trend of opposite move for morbidity and mortality rates does indeed hold true; and then he goes on to review several plausible explanations as to why this may be the case.

2. The distinction of Risk of Falling Sick and Risk of Being Sick

Riley argues that two indicators of the risk of disease - that of point prevalence, indicating the risk of falling sick, and the period prevalence, indicating the risk of being sick, must be distinguished clearly. Indeed, in considering data from modern developed nations this distinction is crucial, for while the former declined, it is the latter that has increased and thereby contribute to the overall increase in morbidity rate. This is due to the fact that the nature of the most prevalent type of diseases have shifted, from acute and fairly short-term diseases ending either in death or recovery to chronic diseases lasting longer durations. As such, it is one of the main conclusion of the article that researchers must pay more systematic attention to the risk of being sick in analyzing morbidity trends of the developed nations. Compared to controlling risks of death and falling sick, the risk of being sick has not been controlled as well by modern health policies. Riley asserts that it is rather misleading to consider acknowledgement of this increase in the risk of being sick as pessimistic, as it is the result of the achievement we have set for ourselves. Future policies should consider about the reduction of the risk of being sick, while continuing to curtail mortality.

3. Why Decline in Mortality Does Not Mean Improvement in Health

Argues against the commonly held notion that assumes when the death rate declines, that fact must indicate the improvement in health. Riley basically notes of two main reasons as to why such simple linkage between morbidity and mortality rates cannot be made. First, the decline in mortality since the 1870's can most aptly be described as a movement toward a disassociation of the traditional linkage between ill health and death. So, since around 1870, the relationship between morbidity and mortality has not been that stable. This would indicate that the morbidity rate cannot be simply deduced directly from the mortality rate. Second reason is the "epidemiologic transition" explanation that focuses on the duration - and thus the risk of being sick - of sickness. This would mean that over time a population may experience fewer cases of illness and injury but the cases experienced may last longer, thereby increasing the morbidity rate - and this is exactly what seems to have happened in the countries Riley studied except Hungary.

4. Trends in Data from Japan, the U.S., Britain, and Hungary

To ascertain this trend with empirical data, Riley reviews mortality and morbidity trends of four nations since 1950's. Here, three nations except Hungary shows a inverse relationship between mortality and morbidity. Further, in these three nations people progressively tended to be more sick with increase in age. Also, the sickness rate increased in each age group in these three nations, over the time period covered. In contrast, in Hungary the exact opposite trend has taken place. Here, the chronic diseases decreased - and the morbidity rate declined, while the mortality rate increased.

5. Review of Theories Explaining Increasing Morbidity Rate

There has been number of explanations offered to explain as to why the average duration of sickness increased, thereby increasing the morbidity rates. They are: (1) People have become more sensitive about health or have adopted higher expectations about their health, (2) Economic incentives are persuading people more readily to consider or present themselves as sick, (3) Improvements in survey methods have led to the discovery of a growing proportion of health problems, (4) Diseases, especially chronic diseases, are being detected earlier, (5) Sicknesses are lasting longer, illnesses and injuries that in former times were resolved in death are now more often resolved, (6) The mortality decline is a cause of the morbidity increase, as people who have been "saved" by the declining mortality rate are precisely the ones who are most likely to experience sickness, (7) The last century has seen a substitution of health risks, with marked increases in diseases with a prolonged course, while diseases with a short course and high incidence decreased. Reviewing these 7 theories, Riley concludes that all but the number 3 is plausible in one way or another. However, it is notable that first 2 explanations are based largely on subjective factors, while the latter 4 are objective. Riley comments that researchers have increasingly shifted their focus away from subjective explanations to objective explanations.

6. Relevance, Critique

Being an introductory text, there seems to be nothing so tricky or controversial in terms of content. As far as the seven theories reviewed explaining the increasing morbidity rate, it is probably right that most of them have at least a grain of truth. How these factors combined exactly to produce the final outcome of increasing morbidity rate is likely to be the appropriate course of future research.