The relative absence of death in our lives is but a smokescreen, a “false and fleeting comfort”, according to the novelist Thomas Maloney in an interesting article in The Guardian, entitled ‘Top 10 deaths in fiction’.¹ Noting obvious medical advances and the changing statistics in infant mortality and infectious disease, he pointed out that death is inevitable for every person. In his article, Maloney – author of Learning to Die – sought to “examine our looming fate in art and literature” in an “attempt to soften that sting”. Acknowledging that it is “a story the living writer is always unqualified to tell”, he highlighted the top 10 descriptions of the subjective experience of death in literature. Examples included the demise of Robert Jordan during the Spanish Civil War, lying injured, having just blown up a bridge in For Whom the Bell Tolls by Ernest Hemingway. Another was the death by guillotine of Sydney Carton in A Tale of Two Cities by Charles Dickens. As the blade descends and slices through his neck, Carton’s consciousness “flashes away” instantly as though witnessed in real time. Even in literature, we may hide from death but it will find us.

In real life, death has changed subtly over the years. According to the World Health Organization, there were 56.9 million deaths worldwide in 2016, 54% of which were due to the top 10 causes of death.² Not surprisingly, the top two were ischaemic heart disease and stroke, accounting for a combined total of 15.2 million deaths, and unchanged as the leading causes of death globally since previously measured in 2000. Chronic obstructive pulmonary disease came third, accounting for some 3 million deaths in 2016, while lower respiratory tract infections was fourth – one of only three deadly communicable diseases on the list. Death due to Alzheimer’s disease and other dementias was fifth, having effectively doubled since 2000, while death due to diabetes (seventh on the list) had also significantly increased from less than 1 million in 2000 to 1.6 million 2016. 

To backtrack slightly, lung, trachea and bronchus cancers were sixth, accounting for 1.7 million deaths. The final three on the list were road traffic fatalities, diarrhoeal diseases and tuberculosis. However, deaths due to these latter two deadly communicable diseases had fallen during the 16 year period, with diarrhoeal diseases and tuberculosis causing 1.4 million and 1.3 million deaths respectively. Interestingly, HIV/AIDS fell off the top-10 list, with its mortality rate having dropped by a third to 1 million.

Of course, the devil is in the detail. Almost three-quarters of fatalities due to road traffic accidents in 2016 involved men or boys. Geography also plays a role, in that the mortality rate due to road traffic injuries in low-income countries was 29.4 deaths per 100,000 population, compared to the global rate of 18.8. Furthermore, over half of deaths in low-income countries were due to the so-called ‘Group I’ conditions (communicable diseases, obstetric complications and nutritional deficiencies), compared to just 7% in high-income countries. Similarly, non-communicable diseases caused 71% of deaths globally in 2016, but this figure was 88% in high-income countries and 37% for low-income countries. 

In the end, the experience of death seems to differ, and not just in literary terms. It depends a lot on when and where you live. Best to heed the advice of writer and physician William Somerset Maugham: “Death is a very dull, dreary affair; and my advice to you is to have nothing whatever to do with it”.

References

1. www.theguardian.com/books/2018/oct/31/top-10-deaths-in-fiction
2. www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death