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Mortality transition in Mexico, 1500-Mortality transition in Mexico, 1500-20002000
» 1500-1650: life expectancy worsened with 1500-1650: life expectancy worsened with Christian colonization: Christian colonization: e0 < 20, fell as low as 5 years during worst times!e0 < 20, fell as low as 5 years during worst times!
» 1650-1810: slow recovery punctuated by 1650-1810: slow recovery punctuated by epidemics and famine, e0 ~15-25 yearsepidemics and famine, e0 ~15-25 years
» 1810-1920: significant improvements undermined 1810-1920: significant improvements undermined by decades of war—1810-20, 1846-68, 1910-20by decades of war—1810-20, 1846-68, 1910-20
» 1920: sustained rise in life expectancy1920: sustained rise in life expectancy
Mexico: life expectancy at Mexico: life expectancy at birth over five centuriesbirth over five centuries
Revolution in life expectancy began in 1920sLife expectancy desperately low til the late 1800s
yea
rs
Mexico: Life Expectancy at birth across the centuriesyear
1500 1600 1700 1800 1900 2000
0
10
20
30
40
50
60
70
80
2016
5
18 20 20
30
15
27
3641
50
5862
6772
75
Five centuries of population change in Five centuries of population change in Mexico (millions log scale)Mexico (millions log scale)
6 Factors to explain the health 6 Factors to explain the health transition transition
and rising life expectancyand rising life expectancy
» 1. Public health1. Public health» 2. Medicine2. Medicine» 3. Wealth and income3. Wealth and income» 4. Nutrition4. Nutrition» 5. Behavior5. Behavior» 6. Education6. Education
The epidemiological transition, The epidemiological transition, 3 stages (Omran)3 stages (Omran)
» 1. Pandemics1. Pandemics
» 2. Receding pandemics2. Receding pandemics
» 3. Degenerative diseases3. Degenerative diseases
Mexico: the last devasting epidemic Mexico: the last devasting epidemic occurred in 1918 (~250,000 deaths)occurred in 1918 (~250,000 deaths)
• *Huey zahuatl (smallpox)*Huey zahuatl (smallpox) 15201520• *tepitonzahuatl*tepitonzahuatl (measles) (measles) 15311531• cocoliztlicocoliztli (Mexican typhus?) (Mexican typhus?) 1546-471546-47
• matlazahuatlmatlazahuatl (typhus?) (typhus?) 1576-771576-77
• famine and typhusfamine and typhus 16921692• typhustyphus 1737-391737-39• the great hungerthe great hunger 1786-881786-88
• typhustyphus 18131813
• *cholera*cholera 18331833
• *influenza*influenza 19181918
* = virgin soil epidemic* = virgin soil epidemic
The Age of Pestilence and Famine: The Age of Pestilence and Famine: Colonial Mexico, 1640-1813Colonial Mexico, 1640-1813Total annual burials from parish registerscrises were more deadly in the 18th century than in the 17th
Bu
ria
ls (
log
ari
thm
ic s
ca
le)
The Age of Pestilence and FamineMortality crises in Cholula (near Mexico City)
1650 1692 1737 1761 1779 1797 1813
10
20
40
100
200
400
1000
2000
4000
10000
20000
smallpox
smallpox
smallpox
smallpox
smallpox smallpoxsmallpox
smallpoxsmallpox
typhus
typhus
typhus
typhus
typhus
typhus
typhus
famine
measlesfamine
measles
Example from Northern Mexico, Example from Northern Mexico, 1630-19301630-1930
Smallpox: 1724, 1748, 1764, 1780, 1803, 1830less than 10% of deaths of known causes due to smallpox
log
rith
mic
sca
le
3 Centuries of Epidemics: Parral, Chihuahua, 1631-1930Interpolated years: 1653, 1658-65, 1818-28
1650 1700 1750 1800 1850 1900
10
100
1000
2000
1639
1671
1693
170517181738
1748
1764
17801787
1803
1810
1814
1837
18491882
1899
1918
1930
Intensity of mortality crises declined after Intensity of mortality crises declined after mid-19mid-19thth century century
Biggest advance in 1940-50s; slowed 1990s1920s: recovery from civil war, rebellion
yea
rs
Mexico: Life expectancy revolution in 20th centuryyear
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
0
10
20
30
40
50
60
70
80
3027
15
27
3641
50
5862
6772
75
The revolution in life expectancy in The revolution in life expectancy in 2020thth century Mexico century Mexico
Civil war, 1910-17
The Mortality transition in Mexico:The Mortality transition in Mexico:catching up with the USAcatching up with the USA
Omran’s epidemiological transitionOmran’s epidemiological transitionMexico, cause of death: decline of parasitic, Mexico, cause of death: decline of parasitic,
contagious; rise of circulatory, cancer, accidentscontagious; rise of circulatory, cancer, accidents
% of deaths by cause (other = ~25%)% of deaths by cause (other = ~25%) parasitic accidents/parasitic accidents/yearyear infectiousinfectious circulatorycirculatory respiratoryrespiratory digestdigest cancercancer homicideshomicides
1930 47.0 1.9 16.0 4.0 0.7 4.1 1930 47.0 1.9 16.0 4.0 0.7 4.1
1940 43.1 3.7 20.0 4.7 1.2 5.1 1940 43.1 3.7 20.0 4.7 1.2 5.1
1950 34.6 6.2 20.7 5.1 2.0 5.9 1950 34.6 6.2 20.7 5.1 2.0 5.9
1960 25.6 8.5 19.3 5.3 3.4 6.5 1960 25.6 8.5 19.3 5.3 3.4 6.5
1970 23.1 10.5 21.8 5.6 4.0 7.2 1970 23.1 10.5 21.8 5.6 4.0 7.2
1980 13.7 16.4 13.5 7.1 6.5 15.5 1980 13.7 16.4 13.5 7.1 6.5 15.5
1990 9.7 19.8 10.5 7.9 10.1 13.9 1990 9.7 19.8 10.5 7.9 10.1 13.9
Timing of principal gains by age varied greatly Timing of principal gains by age varied greatly from one decade to another.from one decade to another.
Civil war, 1910-17
Biggest gains for 50+ since 1980sMexico 1930 - 1997
yea
rs g
ain
ed
Life expectancy gained per decade by age group0
1
2
3
4
5
6
7
8
9
1930-43 1943-60 1960-83 1983-97
0: since 19400: since 1940
Age: timing of gainAge: timing of gain
1-4: 1930-801-4: 1930-80
5-14: 1930-605-14: 1930-60
15-49: 1930-60, 1983+15-49: 1930-60, 1983+
50+: 1943-60; 1983+50+: 1943-60; 1983+
6 factors for explaining the health 6 factors for explaining the health transition and rising life expectancy: transition and rising life expectancy:
the case of Mexicothe case of Mexico
» 1. Public health—substantial efforts from 19191. Public health—substantial efforts from 1919» 2. Education—from the 1940s 2. Education—from the 1940s » 3. Nutrition—improved significantly only from 3. Nutrition—improved significantly only from
1950s1950s» 4. Medicine—important since the 1950s4. Medicine—important since the 1950s» 5. Behavior—deaths from violence (homicides) 5. Behavior—deaths from violence (homicides)
dropped substantially in the 1960s, but accidents dropped substantially in the 1960s, but accidents rose sharplyrose sharply
» 6. Wealth and income—only since the 1970s 6. Wealth and income—only since the 1970s
Public health insurance has risen steady since Public health insurance has risen steady since 1950 & now covers 60%+ of the population1950 & now covers 60%+ of the population
YearYear Population (millions)Population (millions) % insured% insured• 1940 1940 20 20 <1%<1%• 19501950 2626 4 4• 19601960 3535 1111• 19701970 4848 2525• 19801980 6767 4646• 19901990 8181 5959
Literacy (aged 10+) doubled Literacy (aged 10+) doubled 1900-30 and 1930-801900-30 and 1930-80
percent literate of population aged 10+
% li
tera
te
Literacy in Mexico, 1900-1990
0
10
20
30
40
50
60
70
80
90
100
literate
19001910
19201930
19401950
19601970
19801990
Mexico won the race between Mexico won the race between population and grain supply, population and grain supply,
1925-19851925-19851
00
=1
94
5
Mexico: Grain production per capita 1925-1985Indexed values: 1945=100
1925 1935 1945 1955 1965 1975 1985
40
60
80
100
120
140
160
180
200
220
240
Mexican agriculture won the race against Mexican agriculture won the race against population--1940-65population--1940-65
mill
ion
s--
log
sca
le
Race between Population and Grain Productiongrains in millions of tons
corn wheat mexpop
1925 1935 1945 1955 1965 1975 1985
.2
.4
.81
2
4
810
20
40
80
corn
population
wheat
Food availability increase per capita Food availability increase per capita by type: Mexico 1940-1960, 1960-1975by type: Mexico 1940-1960, 1960-1975
Grains, pulses, fruits and veggies all increasedOnly meat and diary did not increase significantly
% in
cre
ase
Food availability increased substantiality, 1940-1975
0
50
100
150
200
BeansCorn
EggsMeat
MilkOranges
PotatoesSugar
TomatoesWheat
Social modernization in Mexico, 1970-2000Social modernization in Mexico, 1970-2000Social conditions improved from 1970 to 1990 and 2000Source: National census microdata
pe
rce
nt
Social modernization in Mexico
0
20
40
60
80
100
electricityliteracy
midschool/+occup:sec
occup:terpipedwater
sewageurban
19701970
19901990
20002000
Mexican middle class emerged slowlyMexican middle class emerged slowly
—since 1950—since 1950 Computed from census data on occupation & income
pe
rce
nt
Long trends in Mexican class structureyear
1900 1920 1940 1960 1980
0
20
40
60
80
100
working
middle
upper
Infant mortality declined from 13% Infant mortality declined from 13% in 1950 to 2.5% in 2005 (still more in 1950 to 2.5% in 2005 (still more than 3 times the US rate of 0.7%).than 3 times the US rate of 0.7%).
6 significant infant mortality risks in 6 significant infant mortality risks in Mexico, 1987-1991: base = 10/1000Mexico, 1987-1991: base = 10/1000
• 1. Mother less than 7 years of schooling1. Mother less than 7 years of schooling 2.3x2.3x• 2. Birth interval <18, >59 months2. Birth interval <18, >59 months 2.3x2.3x• 3. Mother’s age <19, >32 years3. Mother’s age <19, >32 years 1.4x1.4x• 4. Home has dirt floor; no water, sewage4. Home has dirt floor; no water, sewage 1.4x1.4x• 5. Fourth or higher birth5. Fourth or higher birth 1.2x1.2x• 6. Male birth6. Male birth 1.2x1.2x• 7. Rural residence7. Rural residence 1.05x1.05xNote: Note: 1. no data available on mother’s health, nutrition, access to pre-1. no data available on mother’s health, nutrition, access to pre-
natal care, etc.natal care, etc.2. 1980-1995: infant mortality rates by educational levels scarcely 2. 1980-1995: infant mortality rates by educational levels scarcely
changed; even though the overall rate declined by 1/3. Increasing changed; even though the overall rate declined by 1/3. Increasing educational levels of mothers cut IMR from 46 to 33/1000.educational levels of mothers cut IMR from 46 to 33/1000.
6 factors for explaining the health 6 factors for explaining the health transition and rising life expectancy: transition and rising life expectancy:
the case of Mexicothe case of Mexico
» 1. Public health—substantial efforts from 19191. Public health—substantial efforts from 1919» 2. Education—from the 1940s, greatest 1970s 2. Education—from the 1940s, greatest 1970s » 3. Nutrition—improved significantly only from 3. Nutrition—improved significantly only from
1950s1950s» 4. Medicine—important since the 1950s4. Medicine—important since the 1950s» 5. Behavior—deaths from violence (homicides) 5. Behavior—deaths from violence (homicides)
dropped substantially in the 1960s, but accidents dropped substantially in the 1960s, but accidents rose sharplyrose sharply
» 6. Wealth and income—only since the 1970s 6. Wealth and income—only since the 1970s
Mortality transitions: Mortality transitions: Examples from Latin AmericaExamples from Latin America
»Earlier and faster in Argentina, Earlier and faster in Argentina, Uruguay, Cuba, and Costa RicaUruguay, Cuba, and Costa Rica
»Later and slower in Chile, Mexico, Later and slower in Chile, Mexico, Brazil and PeruBrazil and Peru
»Slowest in Guatemala, much of Slowest in Guatemala, much of Central America, and HaitiCentral America, and Haiti
Life Expectancy, 1900-1980, 4 LA Life Expectancy, 1900-1980, 4 LA countriescountries (unequal in 1900; now converging) (unequal in 1900; now converging)
Conclusions:Conclusions:
» France:France:1919thth century: major advances for children century: major advances for children2020thth century: improvement for adults century: improvement for adultssince 1970: improvements for elderlysince 1970: improvements for elderly
»MexicoMexicoAge of pestilence continued to 1918Age of pestilence continued to 1918Major improvements since 1930Major improvements since 1930By 1980, differences between countries had By 1980, differences between countries had narrowed greatlynarrowed greatly
Conclusions:Conclusions:
»Minimal levels of economic and social Minimal levels of economic and social development are sufficient to initiate development are sufficient to initiate the fertility transition. the fertility transition.
»Modest investments in preventive Modest investments in preventive public health could improve quality of public health could improve quality of life and longevity in many regions of life and longevity in many regions of the globe.the globe.
»The demographic explosion is nearly The demographic explosion is nearly over everywhere, except in Africa.over everywhere, except in Africa.