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*Huey zahuatl (smallpox)1520 *tepitonzahuatl (measles) 1531*tepitonzahuatl (measles) 1531 cocoliztli (Mexican typhus?)1546-47cocoliztli (Mexican typhus?)1546-47 matlazahuatl (typhus?) 1576-77matlazahuatl (typhus?) 1576-77 famine and typhus 1692famine and typhus 1692 typhus 1737-39typhus 1737-39 the great hunger 1786-88the great hunger 1786-88 typhus 1813typhus 1813 *cholera 1833*cholera 1833 *influenza 1918*influenza 1918 * = virgin soil epidemic

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

8. Example from Northern Mexico, 1630-1930

9. Mexico, 4 regions, 1680-1815

10. Charity campaign not begun until week nine of epidemic (1797)

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

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

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

14. Omran’s epidemiological transition Mexico, cause of death: decline of parasitic, contagious; rise of circulatory, cancer, accidents % of deaths by cause (other = ~25%) % of deaths by cause (other = ~25%) parasitic accidents/ parasitic accidents/ year infectious circulatory respiratory digest cancer homicides 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

15. 1943-60 gains in life expectancy (8.8 yrs) ~doubled other years (4-4.8 years)

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

17. 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

18. Public health insurance has risen steady since 1950 & now covers 60%+ of the population YearPopulation (millions)% insured 1940 20 <1%1940 20 <1% 195026 4195026 4 1960351119603511 1970482519704825 1980674619806746 1990815919908159

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

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

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

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

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

24. Mexican middle class emerged slowly—since 1950

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

26. 6 significant infant mortality risks in Mexico, 1987-1991: base = 10/1000 1. Mother less than 7 years of schooling2.3x1. Mother less than 7 years of schooling2.3x 2. Birth interval 59 months2.3x2. Birth interval 59 months2.3x 3. Mother’s age 32 years1.4x3. Mother’s age 32 years1.4x 4. Home has dirt floor; no water, sewage1.4x4. Home has dirt floor; no water, sewage1.4x 5. Fourth or higher birth1.2x5. Fourth or higher birth1.2x 6. Male birth1.2x6. Male birth1.2x 7. Rural residence1.05x7. Rural residence1.05xNote: 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.

27. 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

28. 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

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

30. Life expectancy, 150 countries: 1960, 1995

31. Leading mortality crises in the twentieth century

32. Conclusions: » France: 19 th century: major advances for children 20 th century: improvement for adults since 1970: improvements for elderly » Mexico Age of pestilence continued to 1918 Major improvements since 1930 By 1980, differences between countries had narrowed greatly

33. 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.

34. Does HIV/AIDS contradict the epidemiological paradigm (see Bongaarts in PopDevReview 3/96)? » HIV/AIDS is a pandemic-- 20 million cases worldwide: 2/3rds in Africa, 20% in S & SE Asia. » AIDS deaths rates will continue to rise, reaching, by 2005, 0.3-0.4 per thousand population world-wide. » Behavioral change is the best hope; rates of increase in infection are slowing everywhere except in Asia.