Determinants of mortality transition in developing countries before and after the Second World War: Some evidence from Cuba

Abstract

Few studies provide an insight into what factors contributed to declines in the mortality rates of developing countries before the Second World War. In this paper, statistics on causes of death from Cuba, particularly Havana, are used to investigate what may have been some of the principal determinants of mortality decline in the developing world before the arrival of modern drugs and insecticides. Trends in cause-specific mortality are examined in the light of Cuba's social, economic, medical and public health history. The Cuban experience strongly suggests that in this country public health and sanitary reforms and nutritional improvements were largely responsible for initial declines in mortality throughout the first half of the twentieth century. One important finding is that the impact of these reforms and improved nutrition was greatly influenced by prevailing economic conditions. Periods of economic prosperity facilitated declines in mortality; but in times of adversity, the reverse occurred. It appears that during prosperous periods the maintenance and expansion of public health and sanitary facilities were made possible by increased public and private revenues, and that individuals had access to a more abundant diet. The severe economic crisis of the Great Depression had the opposite effect. With the appearance of sulphonamides in the late 1930s, antibiotics, and residual insecticides and other specific measures at the end of the Second World War, the relevance of economic conditions as a determinant of mortality decline diminished. Although this analysis points to the aforementioned trends, the Cuban experience also suggests that other factors enter into the process of declining mortality and that this phenomenon can only be explained as the result of the complex interplay of many forces.

The development and experience of epidemiological transition theory over four decades: a systematic review

“…In his third proposition, Omran stated that ‘During the epidemiologic transition the most profound changes in health and disease patterns obtain among children and young women’. Evidence from many countries in this review supports this claim ( 17 , 32 , 35 , 53 , 56 , 58 , 64 , 66 , 67 , 72 , 75 , 80 , 86 , 95 , 102 , 107 , 114 , 116 , 124 , 128 , 142 , 146 , 158 ). For example, the IMR and perinatal mortality rate decreased steadily in Chile during 1970–1992, while the neonatal mortality rate has been stable since the 1970s ( 75 ).…”

“…Western European countries such as Sweden, United Kingdom, and France took most of the 19th century to shift from Stage 2 to Stage 3 and then a further half-century from Stage 3 to Stage 4 ( 108 , 122 , 124 , 165 ). Cuba, USA, and Australia entered Stage 2 later than many European countries ( 53 , 54 , 66 , 67 , 126 ) but reached Stage 3 almost at the same time. The Netherlands ( 113 ) faced Stage 1, ‘the age of famine and pestilence’, when USA and Australia were encountering Stage 2.…”

“…Mortality decline has been observed with different speeds of transition in the population among all age groups ( 17 , 32 , 34 , 53 , 55 , 61 , 65 , 67 , 75 , 86 , 91 , 98 , 106 , 114 , 116 , 123 , 124 , 145 ) and across specific age groups, including neonates and infants ( 50 , 99 , 117 ), children ( 35 , 56 ), adolescents ( 142 ), and adults ( 73 , 85 , 127 ). In some countries – such as Spain, Japan, Mexico, and Sri Lanka – good quality vital registration allows researchers to study mortality transition over long time periods.…”

Lack of biological mortality bias in the timing of dental formation in contemporary children: Implications for the study of past populations

“…Indeed, it is known that in some preindustrial societies, post neonatal infant mortality is highest in families of low socioeconomic status (Chandrasekhar, 1959; Oris et al, 2004). In addition, mortality from disease in preepidemiological transition settings was observed to be higher in malnourished groups than in better‐nourished peers (Birn et al, 2010; Díaz‐Briguets, 1981). Thus, although mortality may ultimately occur from an acute infection which itself does not impair growth, cumulative insults and infection‐malnutrition synergism leaves a child that may be growth delayed more vulnerable to a final acute infection.…”

Biological mortality bias in diaphyseal growth of contemporary children: Implications for paleoauxology

“…When this is added to the well‐known synergism between infection and malnutrition (Scrimshaw, 2003 ), it is easy to imagine that children who consistently experienced bouts of poor health could become simultaneously growth compromised and susceptible to death, producing biological mortality bias in growth. This is supported by observations from pre‐epidemiological transition societies wherein malnourished children suffered from higher mortality due to disease compared with better nourished peers (Birn et al, 2010 ; Díaz‐Briguets, 1981 ). Therefore, even if child deaths in the past were caused by acute illnesses, this does not preclude the possibility that biological mortality bias in growth affects skeletal samples from these populations.…”