The extensive demographic studies of the 1960s and 1970s analysed a variety of historical changes in mortality patterns of western populations and provided a description of a "normal pathway" for the epidemiological evolution. At the time, there was an expectation that a continuous decrease in mortality and improvements in public health should be indispensable attributes of future development and that all the populations of the world would follow (with different time lags) the leading countries of Western Europe and North America. However, the demographic and epidemiological studies of the 1980s-1990s suggest that many populations and large population sub-groups deviate significantly from the "normal pathway", and are facing growing health problems and even reversals in mortality trends.

In the former Soviet Union and Eastern Europe, life expectancy at birth has been stagnating or lowering during the last three decades. This was due to the increasing mortality from cardiovascular diseases, lung cancer, alcohol-related and violent causes among the young and middle-aged adults. In addition, in the early 1990s, an extraordinary rise in mortality rates was recorded in Russia, the Baltic countries and Ukraine. Some western countries with low mortality rates (e.g. Denmark) were also experiencing an unexpected stagnation in mortality trends during the last decades. Over the 1980s, the gap in mortality between rich and poor, between non-manual and manual workers, and between people with higher and lower educational attainments widened significantly in many industrialised countries. The decline in mortality was always steeper for the better off than for the worse-off. Interestingly, mortality patterns in the most disadvantaged groups within western populations were rather similar to those in countries of Eastern Europe and the former Soviet Union.

The global HIV/AIDS epidemic clearly represents a serious threat for the overall improvement of the world's health. It has been reported that HIV is responsible for a massive increase in death rates among young men and women. In the USA, AIDS was a main contributor to the decrease between 1984 and 1990 in the life expectancy at birth of the African Americans. According to published estimates, between 35% and 75% of all adult deaths can be attributed to AIDS in some African countries. A rapid spread of the infection is taking place in Africa and Asia. For the countries of Eastern Europe and of the former Soviet Union it is a real danger, stored for the near future. In addition, there is some evidence of a re-emergence and emergence of other infectious diseases. They are resistant to therapy by antibiotics and cause an increase in morbidity, disability and mortality throughout the world.

Since the 1970s, very little progress has been achieved in the reduction of the mortality of individuals aged 20 to 50. In many cases, this happens due to increasing mortality rates from violent causes of death. The problem is especially acute in the poor suburbs of many cities in South and North America.

Certainly, health hazards originating from environmental pollution, road traffic accidents, smoking, alcoholism and drug abuse represent a growing threat for the developing world. The situation is especially alarming because the "civilisation pains" are combined with poverty, traditional health and social problems and with insufficient resources.

The aim of the session

The EHT Session should motivate scientific contributions and discussion to a better understanding of the unexpected unfavourable trends in population health and their potential role in the future.

The topics

The following topics are proposed for the EHT Session:

• The regularity of the global epidemiological transition and the unexpected trends in health: a theoretical framework.
• Unfavourable trends in mortality and morbidity in populations and population sub-groups in industrialised countries.
• New health problems in developing countries.
• Emergence and re-emergence of infectious diseases.

Violent death as a growing threat for the urban population.