Routes to low mortality in poor countries revisited

In June 1986, Population and Development Review published a highly influential article by John Caldwell entitled “Routes to Low Mortality in Poor Countries.” Amid growing anxiety over decelerating world mortality decline, Caldwell explored social and political pathways to mortality success on the basis of two lists of superior mortality achievers and exceptionally poor mortality achievers, countries whose mortality rankings drastically differed from their income rankings. To mark the quarter-century since Caldwell's study and chart new pathways, this article looks at the subsequent performance of Caldwell's original exceptional achievers and develops an updated 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; the continued success of China, Vietnam, Cuba, and Costa Rica. dramatic improvements in schooling outcomes, particularly for women, have reduced the importance of education as a determinant of superior achievement. Reinforcing Caldwell's original assertions, the synthesis highlights how interactions between social consensus, health care systems, and human capital dependence offer a pathway to superior achievement. These forces may be especially powerful at moments of national crisis.