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Sir Richard Doll, FRS, FRCP ICRF Cancer Research Studies Unit
Radcliffe Infirmary, Oxford, UK The twentieth century has seen few
changes more remarkable than the improvement in health that has
occurred nearly everywhere, most spectacularly in the economically
developed countries. In these countries improved nutrition, better
housing, the control ofinfection, smaller family sizes, and higher
standards of education have brought about a situation in which more
than 97% of all liveborn children can expect to survive the first
half ofthe three score years and ten that formerly was regarded as
the allotted span oflife. From then on, however, the position is
less satisfactory. Some improvement has occurred; but the
proportion of survivors who die prematurely, that is under 70 years
of age, varies from 25% to over 50% in men and from 13% to 28% in
women, the extremes in both sexes being recorded, respectively, in
Japan and Hungary. Most of these deaths under 70 years of age must
now be called premature, even in Japan. For most of them are not
the result of any inevitable aging process, but instead are the
consequences of diseases (or types of trauma) that have lower-often
much lower-age-specific incidence rates in many of the least
developed countries.
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