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mortality, varying significantly across states within the United States (Sorlie and Gold 1987). |
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Further, different cultures place differential emphasis on causes of death. A recent example is a controversy about Japan's low rate of fatal heart attacks. A traditional reading of the list suggested that this statistic is due to nutritional or environmental factors peculiar to that countrylevel of fat in the diet and so on. Recently, however, some epidemiologists have suggested that the cause may well be that disease is a very low status cause of death within Japanese culture, suggesting as it does a life of physical labor and a physical breakdown. Accordingly, what Americans would call heart attacks often get described as strokes, since an overworked brain is more acceptable there. When this is factored in, they suggest, there is no discrepancy in Japan's figures. These national differences are complicated by the facts that some diseases present differently in different countries. AIDS is one such disease; malaria is another. For the latter, E.J. Pampana noted in an article entitled "Malaria as a Problem for the WHO" that "At a first glance, malaria does not appear to have an international character at all; one could almost say that no other disease is so strictly dependent on local conditions. Malaria might, in fact, almost be called a nationalistic disease, because it takes from the country its very characteristics, as does its folklore. These very local aspects of malaria epidemiology are the bricks with which the science of malariology is built. . . . " (WHO archives 45314). |
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Different national schools of medicine may disagree about issues such as simultaneous causes of death. One WHO committee noted early on that there were indeed such differences; and that if there were no agreement by "reason," then countries would vary according to "facts of pathology (or) clinical medicine, (or) public health importance (WHO archives 45314, 11)." It recommended that the different countries produce a table of contributory causes so that a comparison could be made; however, the problem proved unwieldy. In the Census Manual of the International List of Causes of Death there were 8,300 terms, which represented 34 million possible combinations. If half of the terms could enter into combination, then an assignation of priority in all possible cases would involve sixty-one volumes of 1,000 pages each (CH/E Stats/34 1927, 1011). |
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Finally, handling of the ICD has been politically charged in terms of its internal bureaucracy. Originally, it was run by the French Office Internationale d'Hygiène Publique (OIHP) and was for the French government a sign of its natural diplomatic leadership. When the |
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