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

year

s

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

Bur

ials

(log

arith

mic

sca

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

smallpoxsmallpox

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

logr

ithm

ic s

cale

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

17051718 1738

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

year

s

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

year

s ga

ined

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,

1925-19851925-198510

0=19

45

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

ions

--lo

g sc

ale

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

crea

se

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

perc

ent

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

perc

ent

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-natal 1. no data available on mother’s health, nutrition, access to pre-natal

care, etc.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)

Life expectancy, 150 countries: Life expectancy, 150 countries: 1960, 1995 1960, 1995

Leading mortality crises in the Leading mortality crises in the twentieth centurytwentieth century

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.