demographic yearbook annuaire demographique 1951

CHAPTER II.
DEVELOPMENT OF STATISTICS OF CAUSES OF DEATH
Statistics of causes of death grew out of the need for information
concerning epidemic diseases which from time to
time have taken heavy tolls of the population. These data
have proved invaluable for identifying the locale and measuring
the severity of epidemics, for indicating the effectiveness
of attempts to prevent the spread of epidemic diseases
and for recording progress in the conquest of communicable
disease in general. They have been important guide-posts in
the development of modern programmes of public health
and sanitation. They are basic to any real understanding
of mortality trends and prospects.
With the broadening of health programmes beyond primary
interest in the control of communicable diseases (especially
in areas where these diseases are no longer a major
cause of death), the statistics have become useful in connection
with other aspects of mortality. Information on the
relative frequency of deaths from non-communicable causes
(e.g. from organic or degenerative diseases such as cancer,
diseases of the heart and circulatory system etc., from mental
diseases, from accidents, violence or suicide) points the way
to needed medical research and serves as a guide in the
campaign to remedy various conditions that contribute to
premature or unnecessary loss of life.
While cause-of-death statistics measure the rate at which
deaths from the various diseases occur in a population, they
cannot be taken as a measure or as a reflection of the frequency
with which these diseases occur in the same population
(the morbidity rate). Fatality rates vary widely among
the diseases. Some illnesses (for example, the "common
cold") seldom result in death; others may have fatality rates
approaching 100 per cent. A given disease may have a
higher fatality rate at one time than at another, depending
on the virulence of the organism (in the case of communicable
disease), on the state of medical knowledge or on other
factors. However, significant changes or trends in the death
rate from a given disease generally reflect similar changes
,or trends in the incidence of that disease. Consequently,
cause-of-death statistics have a definite, though limited,
value for indicating the health, or illness, situation of the
living population.
The development of comparability in statistics of causes
of death is one of the most complex and difficult in the
whole field of demography, arising both from the variety
of causes that can produce death and from the variations in
diagnosis or medical practice that occur over time in a
given area and among areas at a given time. As a result,
differences indicated by the recorded figures, even though
the data may be accurate from the statistical point of view,
must be interpreted with some care. This is especially true
with regard to statistics for different countries.
The problem ofinternational comparability has been met,
in part, by the adoption of an internationally agreed list of
causes of death which is revised from time to time as conditions
dictate. Nevertheless, as the discussion that follows
will show, there remain many difficulties that have yet to
be solved.
INTERNATIONAL LISTS OF CAUSES OF DEATH
Historical summary
The need for a uniform classification of causes of death
has long been recognized. The First Statistical Congress,
held in Brussels in 1853, requested Dr. William Farr of the
General Register Office of England and Wales and Dr. Marc
d'Espine, of Geneva, to prepare lists of diseases suitable for
use by statistical offices in the classification ofcauses ofdeath.
They submitted two separate lists to the Second Statistical
Congress, in 1855, and a compromise list was adopted by
the Congress. This list was revised from time to time over
the next thirty years, but it was not generally followed as a
standard of classification.
It was not until 1893 that significant progress was made.
At that time, the International Statistical Institute adopted
a draft list of causes of death, as presented by Jacques
Bertillon on behalf of a special committee previously appointed
by the Institute. It is this list, with its various
revisions, that is still known as the "International List of
Causes of Death."
In 1898, the American Public Health Association recommended
that the list be revised before the beginning of each
decennium in order to reflect appropriately developments
in medical science and statistical procedure. This proposal
was approved by the International Institute of Statistics in
1899, and six revisions have since been made in conferences
convened for the purpose by the French Government in
1900,1909,1920,1929,1938 and 1948. The agenda for the
first three revision conferences were prepared by Jacques
Bertillon. After his death in 1922, a J oint Committee of the
International Institute of Statistics and ofthe Health Organization
of the League of Nations carried out this function.
After the dissolution of the League of Nations, an international
health conference, held in New York in 1946,
requested the Interim Commission of the World Health
Organization to review the list, suggest revisions and undertake
the preparation of an international list of causes of
morbidity, for consideration at the sixth decennial revision
conference. The Interim Commission appointed a committee
of experts to do this work.
The sixth revision conference, held in Paris in 1948,
approved the list submitted by the Expert Committee and
recommended that the World Health Assembly adopt suitable
regulations to ensure international application of the
proposed system of classification. In July 1948, the First
World Health Assembly adopted Regulations No.1 regarding
Nomenclature with Respect to Diseases and Causes of Death. 2
2 See Official Records oj the World Health Organization, No. 13. See
also, World Health Organization, Manual oj the International Statistical
Classification of Diseases, Injuries and Causes of Death, Vol. 1, Geneva,
1948, pages 371-376.
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