The fundamental causes of death theory, medical technologies and inequalities in mortality

Katalin Kovács, Hungarian Demographic Research Institute

According to the “theory of fundamental causes of mortality”, resources – owned by the privileged groups of society – such as knowledge, money, power and beneficial social relations are flexible resources which can be used for improving and maintaining health. According to the theory the appearance of new knowledge and new medical technologies would lead to increasing inequalities in mortality from those causes which are influenced by these new technologies or knowledge. In this paper we investigate education-specific correlates of cause-specific mortality with the spread of some of these new technologies in Hungary. We selected those major medical discoveries which offer proven benefits for mortality from one or more causes of death and about which at least partial data are available for Hungary. These include the spread of hypertension-lowering medications and beta-blockers, as well as two prevention measures (mammography and cervical cancer screening). The first intervention is expected to be associated with mortality from hypertension and stroke, the second with ischaemic heart disease, and the screening programme is obviously related to breast and cervical cancer mortality. We expect the following changes in mortality trends: a) the penetration period of the spread of the medications in the second part of the 2000s and b) the introduction of the pilot screenings in 1995 or 1997 or the introduction of national screening programmes in 2002 and in 2003. According to the expectations we found some limited evidence corresponding to the penetration periods of the appropriate medications in education-specific mortality from stroke and ischaemic heart disease. We found controversial results for education-specific breast cancer mortality and no effect of the interventions on education-specific (and overall) mortality from hypertension and cervical cancer.