Health and urban mortality experience before and throughout the health transition

Using Canadian data, we explore how exposure to influenza very early in life during the pandemic of 1890 may have influenced mortality risk in the subsequent pandemic of 1918, twenty eight years later. As mortality in 1918 peaked at age 28 in Toronto and in other Canadian cities, we posit that infection with influenza in critical periods of development can result in physiological or immunological impairments that increase risk of death from influenza later in life. The peak at age 28 was most evident in large Canadian cities, while the pattern was still present in a less extreme form in rural areas. The 1918 influenza pandemic occurred during the health transition and, through enduring links to the 1890 pandemic, shows that experiences before the transition may have directly influenced the course of the most severe pandemic of this time period. This study provides new empirical insights connecting early physiological insults and immunological experiences to later life mortality.

The objectives of this research are twofold:
1) The estimation of life expectancy at birth for small areas in Mexico for the years 1990, 2000, 2010
2) A spatio-temporal analysis of life expectancy in small areas exploring the existence of convergence clubs
The main purpose is to provide reliable life expectancy estimates at birth for small areas in Mexico. Once achieved, it extends by exploring trend and patterns of these estimates. The aim is to analyze the degree to which patterns of life expectancy are becoming more or less similar at sub-national scales considering between and within regional differences.
This study then considers the fact that small area estimates often convey difficulties because of the small number of events and insufficient exposures, which lead to uncertainty in estimating death rates. This in turn posits several methodological challenges, as the application of standard methods in the calculation of life expectancy, such as life tables, are in general suggested for populations above 5,000.
To undertake this research, data gathering will be possible from secondary sources in Mexico. Population, mortality, and all other required data can be obtained from the Instituto Nacional de Geografia e Informatica.

The fifth Millennium Development Goal (MDG) on maternal health is the most conspicuous failure amongst the MDGs. The lack of an equity focus inherent to the goals has been highlighted previously, with previous studies showing that the population average measurement hides large differences in mortality and morbidity between rich and poor. Skilled birth attendance (SBA) is an important indictor used to monitor maternal health and suffers from great inequality. This paper studies inequality in SBA by socioeconomic status and place of residence for 30 countries over time and highlights countries that have managed to increase SBA more equitably than others. A framework is proposed showing that inequality is a universal stage through which systems pass as maternal health care for a population is improved. There is an ‘inequality transition’, with different groups obtaining skilled attendance at different times. Inequity is an undesirable but unavoidable side effect of progress. The paper outlines how this transition can be used for monitoring and researching equitable progress towards MDG5 and indicates policies that can be enacted at each stage of the framework to reduce inequalities.

Evidences from across several countries hints towards a secular decline in the age at onset of menarche over past two centuries with considerable spatial variations. However, data substantiating any secular trend in the age at menarche among Indian population has been hitherto fragmented and inadequately verified.
Using nationally representative data on 91394 women aged 15-49 years from the Indian Human Development Survey (2005), this research evaluated the cohort specific trends in the age at onset of menarche among Indian women born between 1955-1989. Besides, salient demographic, socioeconomic, and contextual factors determining the age at onset of menarche were also investigated.
The adjusted predicted mean age at onset of menarche among Indian women was 13.76 years (95 % CI: 13.75, 13.77) in 2005. It declined by 3.0 months from 13.83 years (95% CI: 13.81, 13.85) among women born prior to 1955-1964, to nearly 13.62 years (95% CI: 13.58, 13.67) among women born during late 1985-1989. However, there was extensive spatial heterogeneity as adjusted predicted menarcheal age varied from 15.0 years among women from Himachal Pradesh born during 1955-1964 (95% CI: 14.89-15.11) to about 12.1 years among women from Assam (95% CI: 11.63-12.56) born between 1985-1989.

Over the course of the last century, all regions across the globe unexceptionally witnessed major changes in the levels of mortality resulting to a steady rise in life expectancy at all ages. In recent decades, the pace of demographic and epidemiological transition has accelerated in India. Since Independence, India has made huge efforts, however fertility, mortality and morbidity still remain unacceptably high both compared to countries in the region and those at similar income levels. The impact of poverty on health care and vice-versa is significant. These improvements have been unequally distributed across regions among different strata of population. Such diversified health profile of the country raised the question: whether we learnt from the experiences of health transition from those of developed countries and if we are progressing in the right direction towards achieving the goal “Health for All”. Keeping this in perspective, this study made an attempt to understand the social, economic and demographic context of process of health transition at national and regional levels.

In 2011, construction of the Interoceanic Highway to connect the Pacific and Atlantic Oceans was completed. The highway pierces Peru and Brazil’s Amazon regions, and specifically, Peru’s Amazonian province of Madre de Dios (MDD), an emerging economic region undergoing dramatic population growth and environmental change, fueled by urbanization, gold mining, logging, castaña extraction, and ecotourism. Highway construction has increased connectivity and mobility among residents, but two highly vulnerable populations are emerging: one characterized as long-term residents mired in moderate-to-low poverty; and one characterized as newly established migrants who are naïve to potential local threats. High risk/high reward labor opportunities that are spatially diverse, combined with complex family structure make both populations highly mobile and at risk to both chronic and infectious disease. Here, we report results from a population-based study in 2011-12 of residents in MDD, to compare health outcomes (hypertension, overweight/obese, anemia, malnutrition, malaria and dengue) as a function of household vulnerability, resilience, and migration. Data are the most comprehensive ever collected in MDD and results are expected to identify strategies toward sustainable development in countries undergoing rapid transitions.

With the urban population increasing in both number and percentage, urban health inequalities has been rising up the research agenda. A crucial aspect of health, both for the MDGs and the post-2015 agenda, is maternal health. This paper looks at inequalities in the percentage receiving sufficient antenatal care and children born within a facility and assesses how these have changed over time. Countries which have been most successful in reducing inequalities while increasing the proportion of mothers with these services will be studied, and countries which have not succeeded in this way will also be assessed.
Using 125 Demographic and Health Surveys from 33 countries, new measures of wealth were constructed using Principal Components Analysis, applying only to urban residents, based on the assets that the household owns. Wealth was used both as a continuous measure (factor score) and in quintiles. The difference and ratio between richest and poorest quintiles was calculated, while concentration indices calculated.
Results indicated that countries were diverse in the evolution of inequality with some successfully reducing it and others showing an increase over time. Policies to improve maternal health should tackle inequalities, while still increasing the overall level of service use in the whole population.

In the recent literature on young age mortality, quite some attention has been devoted to the spread of deaths between families. Most infant deaths seem to cluster in a rather limited number of families, an observation which has been named ‘death clustering’. Studying infant mortality from a family perspective relocalizes the focus of explanations from individual characteristics to family traits. Family-level explanations might not only enhance our knowledge of causes of infant mortality, it will also improve our understanding of mortality differentials.
This paper aims at studying death clustering over time. The data stems from a historical, 19th century population where mortality levels are still at a constant high, but the early stages of the fertility transition have already been set off. The changing population structure in terms of family sizes affects how mortality is spread between families. Infant mortality will be studied from both a familial perspective, and a hierarchical (multilevel) structure where infant death risks are dependent from one another. By using the perspective of death clustering, the focus is shifted towards the family, enhancing an in-depth look to the relationship of infant mortality and the fertility decline.

The current notion that life in ancient Roman cities was distinctly unhealthy is based primarily on theoretical inferences and qualitative descriptions of life in the city of Rome. Quantitative evidence to assess the health experience of urban and rural residents in the ancient Roman Empire has only become available very recently, through the publication of skeletal studies of markers of ill health. This paper will investigate this new material. It draws together evidence from 29 burial sites, mostly from Italy, to investigate differentials in exposure to ill health between urban and rural populations in the 1st-3rd centuries CE. Focus is on two indicators that are widely considered to be good general, non-specific indicators of health: cribra orbitalia and linear enamel hypoplasias. Preliminary investigations that control for several potential biases in the material yield counterintuitive results. Urban communities score better on both health indicators than rural communities do. In discussing why we might observe this anomalous pattern, I consider various context-specific conditions that may have given Roman urban populations health advantages over their rural counterparts. These include the urban system of aqueducts and that of state-subsidized or free food rations for inhabitants of Europe’s first true metropolis.

Mortality decline is multifaceted, conditioned by many things, most notably the physical environment in which the population lives (nutrition, sanitation, medical technology), and the social environment (social homogeneity and solidarity, inequality, and the control people have over their lives). As mortality declines there is a general shift in age at death towards the upper end of the life span, but the specific details of this shift (the pattern) will vary according to the physical and social environment in which the population lives. The present analysis looks at levels and patterns of mortality over time in the Registration Districts of England and Wales in the second half of the nineteenth century, using ESRC data sets compiled by Woods and Shelton (ESRC 3552) and by Friedlander et al. (ESRC 5587). We show that urban living, rather than industrialisation per se created conditions under which mortality in mid-adulthood (ages 35-60) for men and for women was high relative to mortality at younger ages (under 35). We argue that this is indicative of a premature mortality in mid-adult ages whose causes lie in the organisation of social life in nineteenth century cities and not just in the physical and material conditions under which people lived their lives.