European Journal of Epidemiology

, Volume 28, Issue 3, pp 229–240 | Cite as

Convergence and divergence of life expectancy in Europe: a centennial view

  • Johan P. Mackenbach


It has been noted that national life expectancies have diverged in Europe in recent decades, but it is unknown how these recent trends compare to longer term developments. Data on life expectancy, cause-specific mortality and determinants of mortality were extracted from harmonized international data-bases. Variation was quantified with the inter-quartile range, and the contribution of changing economic conditions was analyzed by comparing observed life expectancy variations with those expected on the basis of changes in levels of national income and/or changes in the relation between national income and life expectancy. During the first decades of the 20th century, variation in life expectancy in Europe increased to reach peak values around 1920, then decreased to reach its lowest values in 1960 (among men) and 1970 (among women), and finally increased strongly again. The first widening was due to less rapid decline in mortality in Southern and Central and Eastern Europe, particularly from infectious diseases, and coincided with an increasing strength of the national income—life expectancy relation. The second widening was due to stagnating or increasing mortality in Central and Eastern Europe, particularly from cardiovascular diseases, and coincided with a very strong rise of between-country differences in national income. Despite some similarities, differences between both episodes of widening differences in life expectancy cast doubt on the idea that the current episode of widening represents a simple delay of epidemiological transitions. Instead, it is an alarming phenomenon that should be a main focus of European policy making.


Life expectancy Mortality Europe History Epidemiologic transition 



The author thanks Dr. France Meslé and Prof. Jacques Vallin (Institut National des Etudes Démographiques, Paris, France) and Dr. Domantas Jasilionis (Max Planck Institute for demographic Research, Rostock, Germany) for sharing some of their data with him. The author thanks Caspar Looman for carrying out the regression analysis that provided the parameters for calculating expected life expectancies, and Wilma Nusselder and Frederik Peters for providing interesting comments on a previous version of this paper.

Conflict of interest

The author declares that he has no conflicts of interest.


  1. 1.
    Vallin J, Meslé F, Adamets S, Pyrozhkov S. A new estimate of Ukrainian population losses during the crises of the 1930s and 1940s. Popul Stud (Camb). 2002;56(3):249–63. (Epub 2003/01/30).CrossRefGoogle Scholar
  2. 2.
    White M. Historical Atlas of the Twentieth Century. 1998 [07-07-2012]; Available from:
  3. 3.
    McMichael AJ, McKee M, Shkolnikov V, Valkonen T. Mortality trends and setbacks: global convergence or divergence? Lancet. 2004;363(9415):1155–9. (Epub 2004/04/06).PubMedCrossRefGoogle Scholar
  4. 4.
    Leon DA. Trends in European life expectancy: a salutary view. Int J Epidemiol. 2011;40(2):271–7. (Epub 2011/03/19).PubMedCrossRefGoogle Scholar
  5. 5.
    Moser K, Shkolnikov V, Leon DA. World mortality 1950–2000: divergence replaces convergence from the late 1980 s. Bull World Health Organ. 2005;83(3):202–9. (Epub 2005/03/31).PubMedGoogle Scholar
  6. 6.
    Zatonski W. Closing the health gap in the European Union. Warsaw: Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology; 2008. p. 227.Google Scholar
  7. 7.
    Robine JM, Le Roy S, Jagger C. Changes in life expectancy in the European Union since 1995: similarities and differences between the 25 EU countries. n.p.: European Health Expectancy Monitoring Unit (EHEMU); n.d.Google Scholar
  8. 8.
    Rechel B, McKee M. Health reform in central and eastern Europe and the former Soviet Union. Lancet. 2009;374(9696):1186–95. (Epub 2009/10/06).PubMedCrossRefGoogle Scholar
  9. 9.
    Leon DA, Shkolnikov VM, McKee M. Alcohol and Russian mortality: a continuing crisis. Addiction. 2009;104(10):1630–6. (Epub 2009/08/18).PubMedCrossRefGoogle Scholar
  10. 10.
    McKee M. Public health in Central and Eastern Europe and the former Soviet Union. In: Beaglehole R, Bonita R, editors. Global public health a new era. Oxford: Oxford University Press; 2009. p. 101–21.CrossRefGoogle Scholar
  11. 11.
    Pomerleau J, Lock K, McKee M. The burden of cardiovascular disease and cancer attributable to low fruit and vegetable intake in the European Union: differences between old and new Member States. Public Health Nutr. 2006;9(5):575–83. (Epub 2006/08/23).PubMedCrossRefGoogle Scholar
  12. 12.
    Stuckler D, King L, McKee M. Mass privatisation and the post-communist mortality crisis: a cross-national analysis. Lancet. 2009;373(9661):399–407. (Epub 2009/01/20).PubMedCrossRefGoogle Scholar
  13. 13.
    Omran AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q. 1971;49(4):509–38. (Epub 1971/10/01).PubMedCrossRefGoogle Scholar
  14. 14.
    Omran AR. The epidemiologic transition theory A preliminary update. J Trop Pediatr. 1983;29(6):305–16. (Epub 1983/12/01).PubMedCrossRefGoogle Scholar
  15. 15.
    Riley JC. Rising life expectancy. A global history. Cambridge: Cambridge University Press; 2001. p. 243.Google Scholar
  16. 16.
    McKeown TF. The origins of human disease. Oxford: Blackwell; 1988. p. 233.Google Scholar
  17. 17.
    Trowell HC, Burkitt DP, editors. Western diseases, their emergence and prevention. Cambridge (Massachusetts): Harvard University Press; 1981.Google Scholar
  18. 18.
    Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. Milbank Q. 1986;64(3):355–91. (Epub 1986/01/01).PubMedCrossRefGoogle Scholar
  19. 19.
    Vallin J, Mesle F. Convergences and divergences in mortality. A new approach to health transition. Demographic research. 2004;SPECIAL COLLECTION 2, ARTICLE 2:11–44.Google Scholar
  20. 20.
    Meslé F, Vallin J. Diverging trends in female old-age mortality: the United States and the Netherlands versus France and Japan. Popul Dev Rev. 2006;32(1):123–45.CrossRefGoogle Scholar
  21. 21.
    Rogers EM. Diffusion of innovations. Glencoe: Free Press; 1962.Google Scholar
  22. 22.
    Vallin J, Meslé F. The segmented trend line of highest life expectancies. Popul and Dev Rev. 2009;35(1):159–87.CrossRefGoogle Scholar
  23. 23.
    Meslé F, Shkolnikov V, Vallin J. Mortality by cause in the USSR in 1970–1987: the reconstruction of time series. Eur J Popul. 1992;8(4):281–308. (Epub 1992/01/01).PubMedCrossRefGoogle Scholar
  24. 24.
    Duthé G, Badurashvili I, Kuyumjyan K, Meslé F, Vallin J. Mortality in the Caucasus: An attempt to re-estimate recent mortality trends in Armenia and Georgia. Demographic research. 2010;22:691–732.CrossRefGoogle Scholar
  25. 25.
    Alderson M. International mortality statistics. New York: Facts on File; 1981.Google Scholar
  26. 26.
    Maddison A. The world economy: historical statistics. Paris: Organisation of Economic Cooperation and Development; 2003.CrossRefGoogle Scholar
  27. 27.
    Preston SH. The changing relation between mortality and level of economic development. Population Studies, 29(2), July 1975. Int J Epidemiol. 2007;36(3):484–90. (Epub 2007/06/07).PubMedCrossRefGoogle Scholar
  28. 28.
    Preston SH. Mortality patterns in national populations, with special reference to recorded causes of death. New York: Academic Press; 1976.Google Scholar
  29. 29.
    Preston SH, Heuveline P, Guillot M. Demography. Measuring and modeling population process. Oxford: Blackwell; 2001.Google Scholar
  30. 30.
    Bongaarts J, Feeney G. How long do we live. Popul Dev Rev. 2002;28(1):13–29.CrossRefGoogle Scholar
  31. 31.
    Luy M. Mortality tempo-adjustment: an empirical application. Demographic Research. 2006;15(21):561–90.CrossRefGoogle Scholar
  32. 32.
    Caldwell JC. Routes to low mortality in poor countries. Population and Development Review. 1986;12(2):171–220.CrossRefGoogle Scholar
  33. 33.
    Fogel RW. The escape from hunger and premature death, 1700–2100. Europe, America, and the third world. Smith R, de Vries J, Johnson P, Wrightson K, editors. Cambridge: Cambridge University Press; 2004. p. 191.Google Scholar
  34. 34.
    Acemoglu D, Johnson S. Disease and development: the effect of life expectancy on economic growth. Cambridge: National Bureau for Economic Research; 2006.CrossRefGoogle Scholar
  35. 35.
    Swift R. The relationship between health and GDP in OECD countries in the very long run. Health Econ. 2011;20(3):306–22. (Epub 2010/03/11).PubMedCrossRefGoogle Scholar
  36. 36.
    Preston SH. The changing relation between mortality and level of economic development. Population Studies. 1975;29(2):231–48. (Epub 2007/06/07).PubMedGoogle Scholar
  37. 37.
    Bloom DE, Canning D. Commentary: the Preston Curve 30 years on: still sparking fires. Int J Epidemiol. 2007;36(3):498–9. (discussion 502-3. Epub 2007/06/07).PubMedCrossRefGoogle Scholar
  38. 38.
    Caldwell JC. Mortality in relation to economic development. Bull World Health Organ. 2003;81(11):831–2. (Epub 2004/02/06).PubMedGoogle Scholar
  39. 39.
    Bank World. World development report 1993. Washington: World Bank; 1993.CrossRefGoogle Scholar
  40. 40.
    Deaton A. Health in an age of globalization. Cambridge: National Bureau for Economic Research; 2004.Google Scholar
  41. 41.
    Mackenbach JP, Looman CWN. Life expectancy and national income in Europe, 1900–2008: an update of Preston’s analysis. International Journal of Epidemiology. Submitted for publication.Google Scholar
  42. 42.
    Robine JM, Le Roy S, Jagger C, team tE. Changes in life expectancy in the European Union since 1995: similarities and differences between the 25 EU countries. n.d.Google Scholar
  43. 43.
    Floud R, Fogel RW, Harris B, Chul Hong S. The changing body. Health, nutrition, and human development in the western world since 1700. Cambridge: Cambridge University Press; 2011.Google Scholar
  44. 44.
    Szreter S. Rethinking McKeown: the relationship between public health and social change. Am J Public Health. 2002;92(5):722–5. (Epub 2002/05/04).PubMedCrossRefGoogle Scholar
  45. 45.
    Ward JW, Warren C, editors. Silent victories. The history and practice of public health in twentieth-century America. Oxford: Oxford University Press; 2007.Google Scholar
  46. 46.
    Cutler DM, Rosen AB, Vijan S. The value of medical spending in the United States, 1960–2000. N Engl J Med. 2006;355(9):920–7. (Epub 2006/09/01).PubMedCrossRefGoogle Scholar
  47. 47.
    Goldman L, Cook EF. The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med. 1984;101(6):825–36. (Epub 1984/12/01).PubMedGoogle Scholar
  48. 48.
    Bots ML, Grobbee DE. Decline of coronary heart disease mortality in The Netherlands from 1978 to 1985: contribution of medical care and changes over time in presence of major cardiovascular risk factors. J Cardiovasc Risk. 1996;3(3):271–6. (Epub 1996/06/01).PubMedCrossRefGoogle Scholar
  49. 49.
    Ezzati M, Vander Hoorn S, Lawes CM, Leach R, James WP, Lopez AD, et al. Rethinking the “diseases of affluence” paradigm: global patterns of nutritional risks in relation to economic development. PLoS Med. 2005;2(5):e133. (Epub 2005/05/27).PubMedCrossRefGoogle Scholar
  50. 50.
    Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. WHO European review of social determinants of health and the health divide. Lancet. 2012;380(9846):1011–29. (Epub 2012/09/12).PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  1. 1.Department of Public HealthErasmus MCRotterdamThe Netherlands

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