Multiple faces of the health transition

It is well known that risk of death during the 1918 Spanish Influenza pandemic was unexpectedly high for those aged 20-40. Analyses of death records show that the greatest number of deaths occurred at the age of 28. It is possible that those people who were born in the period surrounding the 1890 Russian Influenza pandemic were at greatest risk of mortality during the 1918 pandemic, 28 years later. Further, the potential effects of socioeconomic inequality on risk of mortality during the 1918 pandemic has not yet been examined. This paper addresses these two questions using data from Registered Death Records that link individuals who died in Ontario during the pandemic to their birth records. Exact date of birth is used as a proxy for exposure to the 1890 influenza, allowing us to assess the risk of death in 1918 based on prenatal and early life exposure to the 1890 flu. We also link individuals to their entries in the Canadian Census of 1901 and 1911, which provides information on individual socioeconomic conditions over time. We use recently digitized records to investigate the effect of biological insults as well as social structure on mortality during a severe influenza pandemic.

While the relationship between self-rated health and mortality is well established in industrialized country settings, there is little evidence from developing countries. This study seeks to further our understanding of the relationship between self-rated health and mortality in a developing country, through the use of a unique longitudinal dataset from Matlab, Bangladesh. Using panel data from two rounds of the Matlab Health and Socioeconomic Survey and the Matlab Health and Demographic Surveillance System, the study first examines correlates of self-reported health, then the relationship between self-reported health and mortality using logistic regression and Cox proportional hazards analyses. To the extent that people are aware of their health condition regardless of whether they have access to health care, this study is expected to find that self-rated health is a good predictor of subsequent mortality and morbidity. However, the high prevalence of infectious diseases and injuries may mean that previous self-rated health status have little relations to subsequent mortality. The results from this study will provide new insights to a scarcely explored topic on the relationship between self-rated health, mortality, and functional disability in a low-income setting.

With the global paradigm shift in disease burden, behavioural change has been identified as one the major drivers of effective disease management. This study examines risk and preventive health behaviour in Ghana controlling for chronic disease status and socio-demographic factors. Data from the Study on Global Ageing and Adult Health (SAGE) conducted in an adult population 18 years and older with significant focus on those aged 50 years plus were analysed. The study focuses on healthy lifestyle behaviour (HLB) estimated using factor analysis and regression modelling to investigate the association between chronic disease, socio-demographic factors and HLB. An overall higher level of HLB among chronic disease persons was found with age, sex education, employment and wealth still being significant predictors of HLB. The study argues that the significant differential in HLB in favour of chronic disease persons will chart a new pathway for the epidemiological transition with longevity.

With growing emphasis on human development, health has emerged as one of the key areas for policy interventions by governments in many developing countries in general, and India in particular. A large body of evidence now exists to suggest that poverty has a close inter-relationship with health status of the population. Given that poverty is a major outcome of poor health status and low level of human capital, it appears to be vital to bring this to Uttar Pradesh and its regions under serious empirical investigation. For empirical analysis we have considered NSSO morbidity and health care (60th round) data as major source.
Some of the major findings suggest that the postulated relationship is more profound in urban areas than in rural. A possible reason may be the lack of access to health services by rural households due to very acute poverty situation. By implication, it amounts to suggest that a considerable proportion of rural population in parts of UP suffer from serious health issues due to poverty driven inaccessibility of health care and suffer from pains and misery. That it severely affects their productivity and contribution to the economy can be easily inferred.

Married live longer and their advantage tends to increase with time. Whether marital benefits result from selection or protection is still lively discussed. But while the marital advantage increases, the share of the married in the population decreases. We explored the dynamics of marital status mortality differentials in the Czech Republic since 1961. Unlinked death counts and census marital structures were used. The differentials were measured by life expectancy at age 30; its differences and changes were decomposed by the step-wise replacement algorithm. Mortality differences by marital status have considerably increased between 1961 and 1991 due to the worsening survival of the unmarried adults. Since 1991 the differentials rose only slightly and shifted to older age groups. Never-married lag the most, with 9.58 years shorter life expectancy compared to married men (7.70 years for women) in 2010. The decline of marriage and further increase of divorciality resulted in a loss of 0.89 years of the overall male life expectancy. Individuals lacking spousal support were particularly vulnerable before the transition. In spite of their mortality recovery after 1991, they are still far behind the married ones. A plausible explanation is that the marital benefits are now available to more positively selected population.

How socio-demographic characteristics could explain extreme longevity? In this contribution we consider beside age and sex the matrimonial history and the living arrangement trajectory. Data used are extracted from the continuous registration system in Belgium. Compared to longitudinal surveys, administrative data are also suitable for longitudinal studies. They give less information but include the date of death with the situation of the person at death. The method used is survival analysis. 3000 Belgian centenarians are concerned including 659 men. Most centenarians were widowed at death, few were still married while 274 women and 32 men were never married. Among female centenarians, 55% were younger compared to their husband while for male centenarians, 81% were older. Early widowhood favours longevity for women but not for men. For living arrangement, more than half of the centenarians were institutionalized at death but the timing of their entry in nursing home is later compared to the total population. Living in married couple is protective but being single and living alone is also profitable for women only. Concerning the impact of the living arrangement trajectory on survival to extreme ages, living in institution increases mortality risk but this effect decreases at older ages.

This study using nationally representative multiple data sources spanning the period between 1992-2006 investigates whether mother’s empowerment affects children’s nutritional status as measured by z scores on ‘weight for height’, ‘weight for age’ and ‘height for age’. Findings indicate differences in nutritional status by child’s gender, region, caste. Further, multivariate analyses show that relative bargaining index defined as the share of mother’s schooling years over father’s schooling years positively and significantly influence the short term measures of nutritional status of children, namely, z scores of ‘weight- for- age’ and ‘weight- for- height’. However, the estimates of quantile regression suggest that the bargaining power will improve the chronic measure of nutritional status, namely, ‘height for age’ at only the low end of conditional distribution of z score. Additionally, access to health insurance programs and improvement in infrastructure and environment emerge as important factors in reducing child malnutrition.

The present paper aims to study health status of elderly, their morbid condition, perceptions about their own health and treatment seeking behaviour using data based on 60th Round of the National Sample Survey Organization and Census of India 2001. Bi-variate and multi-variate techniques were used to find out the factors affecting health condition and health care utilization of the elderly in India.
The elderly population in India as per the 2001 Census data constitute around 7.4 percent and their proportion to the total population is gradually increasing. The study showed that widows/widowers are having relatively poor health status as compared to currently married elderly. Monthly Percapita Consumer Expenditure (MPCE) is positively related to state of health. Dependency during old age has significant negative impact on the health of the elderly. Male elderly used to take more treatment as compared to their female counterparts. It may be by due to culture of silence and low status of the female elderly. Educational level, occupation and MPCE are found to be important determinant of treatment seeking behaviour.

The study is an effort to analyze the effects of birth interval on neonatal and postnatal mortality
in two selected states in India. The selected states differ significantly based on its socioeconomic
development in the country. By using National Family Health Survey (NFHS)-3 data, the study presents distinct picture of neonatal and postnatal deaths corresponding to different birth intervals in the selected states. In a nutshell, it is evident in the study that the incidence of neonatal are more in Maharashtra whereas the occurrence of postnatal deaths are more in Uttar pradesh. Further, the deaths differentials are analyzed for different background characteristics wherein it is observed that neonatal deaths are more among males and postnatal deaths are more among females. In Uttarpradesh, the rural and urban differentials is insignificant whereas in Maharashtra the occurrence of neonatal and postnatal deaths are high in urban as compared to
rural area.

Poverty is usually associated with food scarcity and under nutrition, but recent statistics tell us that in developed countries there seems to be a correlation between poverty and obesity, the so called Poverty-Obesity paradox. This paper investigates this relation for elderly in Europe using the Survey of Health, Ageing and Retirement. We account for endogeneity with a bivariate probit model, where identification is achieved using regional poverty as instrument for poverty status.