Population Inequities in “The Appointment in Samarra”

By Joseph Chamie
PORTLAND, USA, Jan 7 2026 – While death is inevitable for everyone, the timing of “The Appointment in Samarra” varies significantly among and within populations. Fortunately, mortality levels of human populations have declined significantly worldwide in recent years, leading to increased survival rates and delayed appointments in Samarra.

For example, in the mid-20th century, life expectancies at birth for males and females were 45 and 48 years, respectively. Today, males and females have life expectancies at birth of 71 and 76 years, respectively, which is an increase of more than 25 years. Additionally, females generally have higher life expectancies than males across countries (Figure 1).

Source: United Nations.

Despite impressive global declines in mortality rates, life expectancies at birth vary significantly among countries. Currently, life expectancies at birth for males and females range from highs of about 82 and 87 years, respectively, in Japan and Italy, to lows of approximately 55 and 57 years, respectively, in Nigeria and the Central African Republic.

Inequities in life expectancies at birth persist across different age groups. For example, by the age of 65, country differences in life expectancy remain substantial. In Japan and Italy, life expectancies for males and females at age 65 are approximately 20 and 24 years, respectively. In contrast, the life expectancies for males and females at age 65 in Nigeria and the Central African Republic are about 12 and 13 years, respectively.

Similarly, infant mortality rates vary greatly among countries around the world. The mortality rates of infants range from lows of approximately 2 deaths per 1,000 births in Japan and Italy to highs over 30 times greater, with about 68 deaths per 1,000 births in Nigeria and the Central African Republic.

Longer life expectancies for the world’s population have also led to an increase in the number of centenarians.

In 1950, there were nearly 15,000 centenarians worldwide, making up 0.001% of the global population. Today, there are approximately 630,000 centenarians, accounting for close to 0.01% of the world’s population. By 2050, the number of centenarians is projected to reach 2.6 million, representing around 0.03% of the world’s population (Figure 2).

Source: United Nations.

There are many important factors that influence when and how the appointment in Samarra will occur. These factors include place of birth, residence, sex, socio-economic status, housing, healthcare, nutrition, diet, education, friends, exercise, genetics, disease prevalence, economic stability, public health, injuries, mental health, environmental conditions, political stability, human rights, social support, sanitation, substance use, lifestyle choices, parenting, personal habits, poverty, and violence (Table 1).

Declines in fertility rates have followed mortality rate declines, commonly described as the demographic transition. The fertility rate of the world’s population has fallen from a high of about 5.3 births per woman in the early 1960s to 2.2 births per woman today.

More than half of all countries and areas worldwide have a fertility rate below the replacement level of 2.1 births per woman. In many of these countries, deaths outnumber births, resulting in negative rates of population growth.

For example, in China, deaths began outnumbering births about five years ago. This trend is expected to continue for the rest of the 21st century, leading to population decline and the demographic ageing of the Chinese population.

The timing and circumstances of appointments in Samarra differ among the populations of more developed and less developed countries. People in the latter group are more likely to die from communicable diseases than from noncommunicable diseases, which are chronic conditions typically associated with older, aging populations and lifestyle factors.

Among more developed countries, major causes of death include heart disease, cancer, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. Other leading causes are Alzheimer’s and other dementia, tuberculosis, diarrheal diseases, HIV/AIDS, and external causes and injuries.

Currently, life expectancies at birth for males and females range from highs of about 82 and 87 years, respectively, in Japan and Italy, to lows of approximately 55 and 57 years, respectively, in Nigeria and the Central African Republic

Additionally, in many countries, cancer has replaced heart disease as the leading cause of death. The most common cancers are breast, lung, colon, rectum, and prostate cancer.

Approximately a third of cancer deaths are due to tobacco use, high body mass index, alcohol consumption, low fruit and vegetable intake, and lack of physical activity. Air pollution is also an important risk factor for lung cancer. Many cancers can be cured if detected early and treated effectively.

In many less developed countries, major causes of death include lower respiratory diseases, stroke, heart disease, malaria, and pre-term birth conditions. Other important causes include diarrheal diseases, tuberculosis, birth trauma, and HIV/AIDS.

Another major cause of death in recent years has been the coronavirus or COVID-19. The World Health Organization declared it a global pandemic on 11 March 2020, and it ended in May 2023, but remains an ongoing health threat. The pandemic resulted in over 7 million officially reported deaths worldwide, but the estimated excess morality is significantly higher, ranging between 18 and 35 million.

A crucial factor influencing the timing of appointments in Samarra is the availability of universal health coverage. According to the World Health Organization, universal health coverage ensures that every individual in a country has access to a wide range of health services, from emergency treatments to palliative care, without facing financial difficulties.

As of 2024, 73 out of the 195 countries worldwide were reported to offer some form of universal health coverage, which covers around two-thirds of the global population of 8.2 billion.

Among more developed nations, the United States stands out as a notable exception for not providing universal health care to all its citizens. In 2024, private health insurance coverage remained more prevalent than public coverage, with 66% of the U.S. population being covered. Additionally, the U.S. was noted for having the highest healthcare spending figure per capita in the world.

A significant debate surrounding the appointments in Samarra revolves around the right to die or medically assisted suicide. The differing perspectives about assisted suicide focus on the balance between individual autonomy and the sanctity of life.

Some believe that individuals experiencing unbearable suffering, often due to a terminal illness or incurable condition, should have the legal right and control to decide on medically assisted suicide or voluntary euthanasia. In contrast, others argue that assisted suicide devalues human life and opens the door to potential abuse. They also emphasize the importance of palliative care for those facing illness or personal struggles.

Medically assisted suicide is legal under specific circumstances in a limited number of countries. Those places include Australia, Austria. Belgium, Canada, Colombia, Ecuador, Luxembourg, the Netherlands, New Zealand, Spain, Switzerland, and twelve states in the United States.

In order to be eligible for medical assistance in dying, an individual typically must meet certain criteria. These criteria may include having a terminal illness or disability, being of sound mind, expressing a voluntary desire to die, and being capable of self-administering the lethal dose.

While the appointment in Samarra is inevitable for every human being, the timing of when this appointment will occur remains a topic of debate among the scientific community.

Some believe that there is a fixed limit to human life span, largely attributed to the gradual processes of biological ageing. They stress the implausibility of radical life extension for humans in the 21st century.

On the other hand, some argue that there is no conclusive evidence that the limit of human life span has been reached. The oldest supercentenarian on record, Jeanne Calment of France, lived to be 122 years and 164 days. Some experts predict that this current record of 122 years will be surpassed by the end of the 21st century, possibly even reaching 130 years.

In conclusion, the mortality rates of human populations have decreased globally in recent years, leading to improved chances of survival, longer life expectancies, and a growing number of centenarians. However, the timing and circumstances of the inevitable appointment in Samarra vary, with populations in more developed countries continuing to experience lower death rates and longer life expectancies compared to populations in less developed countries.

Joseph Chamie is a consulting demographer, a former director of the United Nations Population Division, and author of many publications on population matters.