Graph GPD and LE find at first increase GPD increase LE a lot, then not so much.  There are other factors

[image]

“Routes to low mortality in poor countries.” Population and Development Review, 12(2), 171-220.

- Is economic development a prerequisite for mortality decline?

           - Caldwell says no

Examines 3 countries that have much lower levels of mortality than would be predicted based on SES: Kerala, Sri Lanka, and Costa Rica

- All three of the countries examined went through a “breakthrough” period in the mid 20^th century in which mortality, especially child mortality, declined quickly

- Argues that the provision of health care services can markedly reduce mortality, but that certain prerequisites must be met before good and efficient health care can be achieved

1. Public must demand education

     - Religious background of these three countries place value on  achieving enlightenment

    - Furthermore, in these countries girls’ education is valued as much as boys’, which increases the demand for good schooling

    - Educated population → ability to make informed decisions, later marriage, protection of indigenous cultures

2. Female autonomy

- Women must have ability to do as they please and to play a key role in decision-making

- This allows mothers to better care for their child’s health

- Furthermore, women who are better educated are able to make more informed decisions regarding their child’s health

- Ex: In Sri Lanka, British government instituted universal suffrage in 1928 with the express purpose of lowering child mortality

- Increased female autonomy also leads to higher levels of participation in labor force and delayed age of marriage

- Furthermore, when women’s position in society is good, so usually is that of children

- Sons and daughters more likely to be treated equally

- Parents more willing to send children to school rather than have them work

3. Political activity

- Political participation leads to increased social reform

- In all 3 of these countries, grass-roots social movements paved the way for social change, especially in the areas of health and education

- These three laid the groundwork for each country’s mortality breakthrough

- Sri Lanka’s breakthrough occurred 1946-53, Kerala’s breakthrough occurred 1956-71, and Costa Rica’s breakthrough 1970-1980

- During these periods, Sri Lanka’s life expectancy increased 12 years, Kerala’s increased 12 years, and Costa Rica’s increased 7 years

- These breakthroughs corresponded with dramatic improvements in health care

- All countries developed a greater density of health care clinics

- Improved efficiency of health care

- Increase in household health visits (esp. in antenatal period)

- Developed “nutritional floors” for all people (Ex: via school lunch programs)

- These developments allowed new medical technology to move seamlessly through entire population

- Caldwell emphasizes that the interaction of better health care and an educated population is what allowed for these health breakthroughs Having only one or the other doesn’t afford nearly the same benefits

- In sum, unusually low mortality can be achieved if the following inputs hold:

 - Female autonomy

 - Government inputs into health services and education for males and females

 - Health services available to all

 - Health services work efficiently

 - Basic nutrition provided to all

 - Universal immunization

 - Concentration of health care on periods right before and after birth

- Caldwell advocates that investing in education (particularly female education) and health is the route to lower mortality for all

  - Low mortality will not come as a spinoff from economic growth

“Social change and mortality decline.” In Women’s Position and Demographic Change.  Edited by Federici, Mason, and Sogner.  New York: Oxford University Press.  Pp. 190-212.

- Women have a mortality advantage in most developed countries

- The excess mortality of men is believed to be largely biological

- Demographers and scientists have attempted long attempted to quantify this “natural” mortality advantage among women;

- Most common estimate is that women can expect to live 2 years longer than men

However, in developing countries, as well as in developed countries in the past, women’s mortality is often higher than men’s

- Lots of excess mortality for women during the reproductive years due to the hazards of childbirth

- Also excess mortality of female children perhaps due to lower valuation of girls compared to boys (girls given less access to nutrition, hygiene, and medical facilities)

- In these countries more girls die of infectious diseases than boys

- Economic and social progress has been accompanied by a reduction of the difference between the social status of men and women and allowed them to gain a mortality advantage over men

This advantage is even greater than what we would expect if men and women behaved in identical ways

- In the period 1974-1978, men had greater mortality than women at every age

- In infancy, boys more likely than girls to die of genetic defects

- In young adulthood, boys more likely than girls to die of accidental causes

- In late adulthood, men more likely than women to die of degenerative diseases, neoplasms, and malnutrition

However, it is difficult to say to what extent the current mortality advantage of women is due to social or biological factors

- However, women’s participation in certain behaviors that have long been characteristic of men, such as smoking, drinking, driving cars, and working outside the home, should have caused their mortality to converge with men’s; why hasn’t this happened?

- Women are still given “protected status” in society more so than men

- Although more women are engaging in risky, masculine behaviors, they do so to lesser degree than men

- Women less likely to perform manual labor than men

- Women tend to utilize medical services more and take better care of their health than men

Children born in the Harvest Season in Gambia have better survival rates at every age.

This is slight until 20-25 when it gets larger and widens for the rest of the lifespan.

“The uneven tides of the health transition.” Social Science and Medicine, 55, 313-322.

- Uses the Global Burden of disease data to compare mortality patterns of the 20% of the world population living in the poorest countries, provinces, and states and the 20% of the world’s population living in the richest countries

- Find that poorest populations experience higher mortality in each of the three main groups of mortality, but that the excess mortality of the poorest populations is mostly due to their higher incidence of communicable diseases (77% of excess deaths)

- These diseases only account for 34.2% of deaths in the world but still dominate mortality among the poorest 20% of the world’s population (58.6% of deaths)

- Although developing countries have, to a certain extent, undergone an epidemiological transition, poorest populations still suffer from Group I diseases (in a sense they have been left behind by the epidemiological transition)

- This is partially due to the young age structure of poorer populations, but finding persists even with age standardization

- Most likely this trend has only gotten worse with the increase of AIDS

 in relation to india

argues that starvation and famines in general may not be due to food scarcity but lack of entitlement to food

“The hidden penalties of gender inequality: Fetal origins of ill-health.” Economics and Human Biology, (1), 105-121.

Missing Women

- Main argument is that gender inequality harms the health of the entire population

- Overlapping health transitions in the developing world describe a regime in which both communicable diseases and chronic diseases are prevalent simultaneously

- Communicable diseases tend to affect children in poorer segments of the population whereas chronic diseases tend to affect adults in relatively better-off segments of the population

- Authors argue that both of these patterns are exacerbated by the common factor of maternal deprivation operating via fetal deprivation

- In Southeast Asia, mortality rates of women much higher than men

- Estimate 37 million “missing women” in India alone (women that would be alive if it were not for gender inequality)

- 100 million missing women worldwide

- Systematic biases against women -> higher mortality rates among women and averting of women that would have been born

- Authors suggest that gender bias -> maternal undernutrition -> low birthweight -> both child malnutrition and adult poor health

Two types of pathways link low birthweight to adult ill health

- Low birth weight babies may suffer from malnutrition and growth retardation in childhood and typically grow up to be adults of short stature and low BMI

- Barker Hypothesis: Low birthweight infants have bodies and organs that expect to be in a nutrient-poor environment for the rest of their lives

- Babies born with a low birthweight may be better-off in a nutrient poor environment than babies born at normal birthweight because their bodies adapted in the womb

- Babies born with a low birthweight that grow up in a normal or nutrient-rich environment may have more health problems than if they had grown up in a nutrient poor environment because they are more likely to suffer from hypertension, type II diabetes, cardiovascular disease, lung disease, and renal damage

- This hypothesis is supported by the fact that Indian adults have the highest rates of diabetes in the world

- In sum, gender inequality essentially leads to a double jeopardy—simultaneously aggravating both regimes of communicable and chronic diseases and raising the economic cost of the overlapping health transition

- Policies aimed at reducing gender inequality might be the most effective means of preventing these health problems

“The timing and pace of health transitions around the world.” Population and Development Review, 31(4), 741-764.

Aim of article is to describe regional and global life expectancy gains across time and space

3 divergent trends in life expectancy since the early 1980s

1. Most countries, even those with already high levels of life expectancy, continued to add years at a fairly robust pace

2. A second group of countries that were previously part of the Soviet Union saw a stagnation or slight decline in life expectancy, particularly among males

3. A third group of countries, primarily in central and southern Africa where HIV/AIDS in rampant, saw a dramatic decrease in life expectancy by as much as 19 years

- It is often difficult to determine when a health transition begins

- Population composition can greatly affect death rates

- For example, in GB and FR in the mid-1800s, death rates at the national level appeared to be stagnant, but in reality death rates were decreasing while greater numbers of people were migrating to urban areas (where death rates were higher)

- Countries that began the health transition prior to 1850 experienced slower gains in life expectancy than countries that began the transition more recently

- It is difficult to generalize common causes of life expectancy gain because countries have experienced gains under very diverse circumstances

- Gains have been made under differing stages of economic development, historical conditions, and levels of literacy and education, among other things

- Riley suggests that rather than studying mortality transitions in one country during one period in time, a more comparative approach is necessary to test specific explanations that may be relevant for reducing mortality in countries where life expectancy is still low

  “Measuring the global burden of disease and epidemiological transitions: 2002-2030. Annals of Tropical Medicine and Parasitology, 100(5), 481-499.

- The aim of the Global Burden of Disease Study was to assess global patterns of disease burden and recommend interventions

- This articles utilizes a measure called the Disability Adjusted Life Year (DALY)

- Composed of years of life lost due to premature death and years of life lived with disability

Diseases classified into 3 groups

   - Group I: Communicable diseases

   - Group II: Non-communicable diseases

   - Group III: Injuries

- Find that globally ½ of deaths among 15-59 year olds in 2002 due to Group II and 1/3 due to Group I

- If HIV is removed, only 1/5 of death due to Group I

- Group I deaths predominate in low and middle income countries (esp. in Africa)

- Ten leading causes of disease differ in low/middle income countries versus high income countries

- 3 main causes of death globally are cardiac diseases, stroke, and respiratory diseases

- In high income countries, depression, heart disease, and cardiovascular disease are the three main causes of loss of productive life years

- In low/middle income countries, perinatal conditions, respiratory infections, and AIDS are the three main causes of loss of productive life years

- These diseases rank much higher in terms of years of life lost than the leading causes in high income countries

- People in developing countries not only have lower life expectancies, but they also live a larger proportion of their lives in poor health

Small number of risk factors account for a large percentage of mortality and disease burden

These include poor nutrition, unsafe sex, smoking, and alcohol use

- Policies and programs that target these risk factors could reduce multiple causes of poor health

- Over the next 30 years, authors predict decrease in overall Group I diseases, except for HIV/AIDS

Also predict increase number of deaths caused by Group II and III diseases

Determinants of reduction in maternal mortality in Bangledesh - 30 yr cohort study

Found a decrease in maternal moraltiy in a 30 yr periods with international and gov't interventions.

Better health care, midwives, safer abortions helped

But women's education and financial assitance for the poor and poverty reduction are essential.

“Reform and support systems for the elderly in developing countries: Capturing the second demographic dividend.” Genus, 62(2), 11-35.

The authors show that the demographic transition and population aging present two opportunities for economic growth

The first demographic dividend arises because the working age population is growing more rapidly than the consuming population due to decreases in fertility and mortality at younger/middle ages

- Provides an extra boost to income per capita

- However, this demographic dividend is transitory because the number of consumers will grow faster than the number of workers as a large part of the population becomes concentrated at older ages

The second demographic dividend arises because fewer children and a longer life create a powerful incentive for individuals to accumulate capital to provide for old age

- Investing this capital in the domestic or global economy will result in rapid growth of output per worker

- Parents investing in the human capital of their children (through education) would also produce a second demographic dividend

- Furthermore, this process could have a permanent positive effect on the economy

If, however, individuals rely on familial or public transfers to provide for old age, this will not increase output per worker

- It is therefore the responsibility of law-makers and public policy to encourage people to save and invest their money by creating and supporting the necessary financial institutions

- Authors conclude that the pessimistic predictions regarding the effects of population aging on economic growth are not necessarily warranted, so long as aging countries exploit the economic potential of the second demographic dividend

“On the determinants of mortality reductions in the developing world.” Population and Development Review. 33(2), 247-287.

Aim of article is to examine the determinants of the improvements in life expectancy in the developing world after WWII

- Life expectancy at birth in developing countries rose from about 45 years at the end of the 19^th century to above 75 years in 2000

- For many developing countries, gains between 1960 and 2000 exceeded 20 years (World Bank, 2005)

- Life expectancy in less developed countries has been increasing at a much faster rate than in more developed countries

  - Increases in life expectancy have traditionally been linked to increases in income

- Fogel argues that nutrition is the key mechanism via which income influences health

- Social scientists have become increasingly aware of a decoupling of these factors

- Preston (1975, “The Changing Relation between Mortality and Level of Economic Development”) demonstrated that since at least 1930, constant levels of income has been associated with greater levels of life expectancy (positive shift in life expectancy relative to income)

- Preston (1980) finds that roughly 50% of the reduction in mortality was due to “structural factors” unrelated to nutrition or economic development

- Although there still remains a fairly strong relationship between income per capita and life expectancy at birth, most researchers agree that the relationship between economic growth, nutrition, and mortality is insufficient to explain improvements in life expectancy in the 20^th century

- Research on causes of death in the developing world have generally found that about half of the reduction in mortality throughout the second half of the 20^th century was due to improvements in material conditions and half was not

- Preston (1980) found that decreases in infectious diseases, diarrheal diseases, and influenza/pneumonia/bronchitis were the biggest contributors to the mortality decline

- Improved living standards most likely operated primarily through reductions in influenza/pneumonia/bronchitis, whereas improved sanitary conditions likely reduced infectious and diarrheal diseases

- Less developed countries typically witness mortality reductions among children and infants; as development level increases mortality improvements shift toward older ages

- Suggests epidemiological transition in developing countries from infectious diseases being the leading cause of death to chronic conditions being the leading cause of death

- One “structural factor” that likely reduced mortality in poorer countries includes diffusion of new technologies via ideas, personal health practices, and public goods

- These ideas, practices, and public goods include immunization, improved sanitation and access to water, and education; all important for reducing mortality

- Education, sanitation, and access to water and medical services also may explain within country variations in mortality

- In terms of the relative contributions of each of these factors, evidence points toward maternal education as being particularly influential in reducing child and infant mortality

- Haines and Avery (1982) posit that better educated mothers may seek medical care more actively, may be more aware of sanitary precautions, nutritional info, and health services, and may be better able to recognize serious health conditions

- Caldwell (1986) suggests that schooling familiarizes individuals with Western values and makes them less resistant to medical technologies

“The exceptionally high life expectancy of Costa Rican nonagenarians.” Demography, 45(3), 673-691.

 2 major hypotheses exist for why mortality rates are declining and the death rates of the oldest-old are decelerating

1. The heterogeneity in frailty hypothesis suggests that frail people die off when conditions are harsh at younger ages, leaving only the hearty among the oldest old

- Past improvements in health conditions at early ages may be benefiting today’s elderly

2. The heterogeneity in frailty hypothesis suggests that poor conditions early in life may strengthen a cohort at older ages

- Absence of accurate data about old-age mortality in low-income populations has been a major obstacle to examining this hypothesis

- Author hopes to shed some light on this theory using data from Costa Rica

- Costa Rica has notoriously good vital statistics and exceptionally high old-age longevity

Results

- Costa Rica does have significantly higher life expectancy at age 90 than low-income countries

- A comparison with the US and Sweden suggests that this advantage is mostly due to lower cardiovascular disease mortality among Costa Ricans

- Costa Ricans also have much lower prevalence of obesity

- Government emphasis on health care may also contribute to advantage

- The Costa Rican advantage (compared to high-income countries) is particularly large for males, although male life expectancy at age 90 is still 0.3 years less than that of females

- Although this analysis cannot really get at why these patterns occur, author suspects it may be due to a heterogeneity of frailty effect, in light of the fact that this cohort of individuals survived exceptionally high infant mortality rates due to infectious diseases

- If this is the case, the exceptional longevity of Costa Ricans may decline as new, less hearty cohorts age

What explains the rural-urban gap in infant mortality in Africa, household or community characteristics?

In rural 2/3 of increased mortality is due to observed and unobserved hh characteristics

(i.e. safe wather, electricity, quality of housing, finished floors, mom's age, mom's education, birth interval, contraception, birth order)

community characteristics explain 1/4 of gap (2/3 in unobserved hetereogenity and 1/3 observed)

In rural areas IMR is 14%

in Urban 9.6%

“Mortality crossovers: Reality or bad data?” Population Studies, 40(3), 389-401.

- The mortality crossover refers to the fact that countries with relatively high death rates in the early and middle years of life sometimes report very low death rates in the later years of life, causing the mortality schedule of these countries to cross that of countries with low death rates in the early and middle years of life

- For instance, the proportion surviving from ages 5 to 70 in the Soviet life table of 1926 was only about 50%, compared to 80% in recent life tables for Sweden and Japan, yet the expectation of life at the 70^th birthday in the U.S.S.R. was greater than that of present day Japan or Sweden

2 possible explanations for this pattern

1. Adverse conditions experienced at younger ages in certain populations eliminate the least resistant (most frail) members of these populations resulting in very low mortality among the highly selected survivors to older ages.

2. Data from which mortality rates are calculated in certain populations are biased in a way that causes a severe understatement of death rates at older ages.

Authors use cross-national data to examine each of these hypotheses

- Find that in populations for which data on deaths are highly reliable (such as Japan, Sweden, Norway, and the Netherlands), there actually exists a close positive relationship between mortality at younger and older ages

- In countries where age misreporting is common, low mortality at older ages is often accompanied by high mortality at younger ages

- Age misreporting often involves age heaping and age overstatement among the elderly

“Generational transfers and population aging in Latin America.” Population and Development Review, 37, 143-157.

Author examines some of the probable effects of population aging in Latin America

- Notes that population aging may have negative or positive effects on the economies of these countries

- The human life cycle typically involves long initial and final periods of dependency and an intermediate period in which people produce more than they consume

3 ways in which individuals, families, and societies organize themselves to meet the “life-cycle deficit” at younger and older ages include:

1) intergenerational private transfers (parents to kids or kids to parents),

2) intergenerational public transfers (taxes to support institutions for the young and old), and

3) intragenerational reallocations from middle to older ages (savings and asset accumulation)

Patterns of population aging in Latin America

- Recent fertility decline has led to very rapid population aging

- Much faster than in Western Europe and the US

- The population aged 65+ is expected to grow from about 5% in 2000 to 20% in 2050

- Uses data from the National Transfer Accounts project (NTA) to examine patterns of transfers in Latin America and to simulate their potential effects on various economic indicators

Results

- Finds evidence for first demographic dividend (growth in consumption has been smaller than growth in labor income)

- Finds evidence for second demographic dividend (asset income growing faster than labor income)

- Different types of transfers characteristic of the young and old

- Young more likely to receive private transfers from parents and public transfers in the form of education

- Old more likely to rely on asset accumulation and public income transfers from the government

- Elderly receive much higher public transfers than young people (for instance, in Brazil net public transfers make up 81% of consumption among people over age 65)

- Increase aging may render these old age public transfer systems in Latin America untenable in the near future

- The elderly are far from being a net economic burden on their families; the economic transfers they provide to their families are much larger than those they receive

- Although 71% of elderly do co-reside with children/grandchildren, surveys suggest that it is children who are living in their parents’ hh rather than vice versa

- Overall, the economic effects of population aging in Latin America appear to be positive

- Evidence of capital accumulation (good for national economy) and downward private transfers (good for younger generations)

- Policy changes may need to occur to transform current public transfer systems

“Mortality crossovers: Reality or bad data?” Population Studies, 40(3), 389-401.

- The mortality crossover refers to the fact that countries with relatively high death rates in the early and middle years of life sometimes report very low death rates in the later years of life, causing the mortality schedule of these countries to cross that of countries with low death rates in the early and middle years of life

- For instance, the proportion surviving from ages 5 to 70 in the Soviet life table of 1926 was only about 50%, compared to 80% in recent life tables for Sweden and Japan, yet the expectation of life at the 70^th birthday in the U.S.S.R. was greater than that of present day Japan or Sweden

2 possible explanations for this pattern

1. Adverse conditions experienced at younger ages in certain populations eliminate the least resistant (most frail) members of these populations resulting in very low mortality among the highly selected survivors to older ages.

2. Data from which mortality rates are calculated in certain populations are biased in a way that causes a severe understatement of death rates at older ages.

Authors use cross-national data to examine each of these hypotheses

- Find that in populations for which data on deaths are highly reliable (such as Japan, Sweden, Norway, and the Netherlands), there actually exists a close positive relationship between mortality at younger and older ages

- In countries where age misreporting is common, low mortality at older ages is often accompanied by high mortality at younger ages

- Age misreporting often involves age heaping and age overstatement among the elderly