Mortality transition in Mexico, 1500-2000

1. Mortality transition in Mexico, 1500-2000 • 1500-1650: life expectancy worsened with Christian colonization: e0 < 20, fell as low as 5 years during worst times! • 1650-1810: slow recovery punctuated by epidemics and famine, e0 ~15-25 years • 1810-1920: significant improvements undermined by decades of war—1810-20, 1846-68, 1910-20 • 1920: sustained rise in life expectancy

2. Mexico: life expectancy at birth over five centuries

3. Five centuries of population change in Mexico (millions log scale)

4. 6 Factors to explain the health transition and rising life expectancy • 1. Public health • 2. Medicine • 3. Wealth and income • 4. Nutrition • 5. Behavior • 6. Education

5. The epidemiological transition, 3 stages (Omran) • 1. Pandemics • 2. Receding pandemics • 3. Degenerative diseases

6. Mexico: the last devasting epidemic occurred in 1918 (~250,000 deaths) • *Huey zahuatl (smallpox) 1520 • *tepitonzahuatl (measles) 1531 • cocoliztli (Mexican typhus?) 1546-47 • matlazahuatl (typhus?) 1576-77 • famine and typhus 1692 • typhus 1737-39 • the great hunger 1786-88 • typhus 1813 • *cholera 1833 • *influenza 1918 * = virgin soil epidemic

7. The Age of Pestilence and Famine: Colonial Mexico, 1640-1813

8. Example from Northern Mexico, 1630-1930

9. Intensity of mortality crises declined after mid-19th century

10. The revolution in life expectancy in 20th century Mexico Civil war, 1910-17

11. The Mortality transition in Mexico:catching up with the USA

12. Omran’s epidemiological transitionMexico, cause of death: decline of parasitic, contagious; rise of circulatory, cancer, accidents % of deaths by cause (other = ~25%) parasitic accidents/ yearinfectiouscirculatoryrespiratorydigestcancerhomicides 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 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 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 1990 9.7 19.8 10.5 7.9 10.1 13.9

13. Timing of principal gains by age varied greatly from one decade to another. Age: timing of gain 50+: 1943-60; 1983+ 15-49: 1930-60, 1983+ 5-14: 1930-60 1-4: 1930-80 Civil war, 1910-17 0: since 1940

14. 6 factors for explaining the health transition and rising life expectancy: the case of Mexico • 1. Public health—substantial efforts from 1919 • 2. Education—from the 1940s • 3. Nutrition—improved significantly only from 1950s • 4. Medicine—important since the 1950s • 5. Behavior—deaths from violence (homicides) dropped substantially in the 1960s, but accidents rose sharply • 6. Wealth and income—only since the 1970s

15. Public health insurance has risen steady since 1950 & now covers 60%+ of the population Year Population (millions) % insured • 1940 20 <1% • 1950 26 4 • 1960 35 11 • 1970 48 25 • 1980 67 46 • 1990 81 59

16. Literacy (aged 10+) doubled 1900-30 and 1930-80

17. Mexico won the race between population and grain supply, 1925-1985

18. Mexican agriculture won the race against population--1940-65 population corn wheat

19. Food availability increase per capita by type: Mexico 1940-1960, 1960-1975

20. 2000 1990 1970 Social modernization in Mexico, 1970-2000

21. Mexican middle class emerged slowly—since 1950

22. Infant mortality declined from 13% in 1950 to 2.5% in 2005 (still more than 3 times the US rate of 0.7%).

23. 6 significant infant mortality risks in Mexico, 1987-1991: base = 10/1000 • 1. Mother less than 7 years of schooling 2.3x • 2. Birth interval <18, >59 months 2.3x • 3. Mother’s age <19, >32 years 1.4x • 4. Home has dirt floor; no water, sewage 1.4x • 5. Fourth or higher birth 1.2x • 6. Male birth 1.2x • 7. Rural residence 1.05x Note: 1. no data available on mother’s health, nutrition, access to pre-natal care, etc. 2. 1980-1995: infant mortality rates by educational levels scarcely changed; even though the overall rate declined by 1/3. Increasing educational levels of mothers cut IMR from 46 to 33/1000.

24. 6 factors for explaining the health transition and rising life expectancy: the case of Mexico • 1. Public health—substantial efforts from 1919 • 2. Education—from the 1940s, greatest 1970s • 3. Nutrition—improved significantly only from 1950s • 4. Medicine—important since the 1950s • 5. Behavior—deaths from violence (homicides) dropped substantially in the 1960s, but accidents rose sharply • 6. Wealth and income—only since the 1970s

25. Mortality transitions: Examples from Latin America • Earlier and faster in Argentina, Uruguay, Cuba, and Costa Rica • Later and slower in Chile, Mexico, Brazil and Peru • Slowest in Guatemala, much of Central America, and Haiti

26. Life Expectancy, 1900-1980, 4 LA countries (unequal in 1900; now converging)

27. Life expectancy, 150 countries: 1960, 1995

28. Leading mortality crises in the twentieth century

29. Conclusions: • France:19th century: major advances for children20th century: improvement for adultssince 1970: improvements for elderly • MexicoAge of pestilence continued to 1918Major improvements since 1930By 1980, differences between countries had narrowed greatly

30. Conclusions: • Minimal levels of economic and social development are sufficient to initiate the fertility transition. • Modest investments in preventive public health could improve quality of life and longevity in many regions of the globe. • The demographic explosion is nearly over everywhere, except in Africa.