posit that better educated mothers may seek medical care more actively, may be more aware of sanitary precautions, nutritional info, and health services, and may be better able to recognize serious health conditions

 Fatal Years: Child Mortality in Late 19^th Century America. Princeton, NJ: Princeton University Press.

Preface

- Prehistoric man lived an average of 20-25 years; today average life expectancy in the US is 75 years

- Approximately half of the gains in life expectancy occurred in the 20^th century, as life expectancy around 1900 was approximately 50 years

- One aim of book is to provide info on the levels, trends, and differences in child mortality in the US at the turn of the century

- Second aim is to explain these trends

Chapter 1

- At the turn of the century nearly 2 out of 10 children died before reaching their 5^th birthday

- This level of mortality is much higher than in either Asia or Latin America today

- Most deaths due to infectious diseases (diarrheal, respiratory, etc.)

- In the late 19^th century germ theory became increasingly accepted, however old medical practices were slow to change

- Overall, for most diseases, prevention was more important than specific therapy

- The biggest advance related to the new knowledge on disease mechanisms came in the form of public health (sewage disposal, milk cleanliness, pure water, health education)

- Parenting practices (particularly of the mother) exceedingly important for child health

- This is illustrated by the fact that the infant mortality rate for babies whose mother died within 2 months of childbirth was 625 per 1000

- Children whose mother worked outside of the home also had much higher mortality rates

- Breastfeeding reduced child mortality by preventing exposure to unclean milk

- Contemporary reports suggest that parents were motivated to increase their children’s survival chances but often lacked the knowledge to do so

Social and economic influences on mortality

Urbanization: Concentration of many people accelerated spread of disease, but it also facilitated the deployment of health services

Occupation: Percent of population employed in industry positively correlated with infant mortality; mothers’ labor force participation positively correlated with infant mortality

Ethnicity and Nativity: Immigrants tended to have higher death rates than natives, but lots of variability existed in death rates across immigrant groups

Literacy and Income: Inverse relationship between fathers’ earnings and child mortality: appears to operate through access to better housing

Diet: Children’s diets probably improved at the turn of the century as did the diets of the adult population; urban residents likely had access to a greater variety of food

Chapter 5

- In order to better understand the factors that influence child mortality, the authors compared child mortality differentials in England and Wales in 1911 to a set of 11 developing countries in the 1970s

- In England and Wales, large child mortality differentials existed between urban/rural areas, by fathers’ occupational status, by whether the mother worked, by # of rooms in house, and between Irish immigrants and native born

- Compared to the US at the turn of the century, England and Wales had greater health inequality by SES

- This is partially attributable to the fact that professional and white-collar groups in the US had a smaller mortality advantage than those in GB, maybe because these groups in GB had higher social standing

- In general, GB had greater income inequality than the US

 - GB may also have had greater residential segregation by occupational class than the US

- Mortality differences between US at the turn of the 20^th century and developing countries today

- In the US in 1900, urban residents had 28% higher mortality compared to rural residents; in developing countries today, urban residents have 23% lower mortality

- Lower mortality attributable to urban residents’ higher social standing

- Occupational differences in mortality much smaller in the US in 1900 than in developing countries today

- Overall, the US in 1900 had much higher child mortality than today’s developing world in every occupational class except agricultural workers

- Even though occupational differences in mortality were relatively small, racial differences in mortality in the US in 1900 were enormous

- Preston and Haines conclude that the widespread failure to achieve satisfactory child mortality at the turn of the century was due to a lack of knowledge about disease and a failure to implement techniques that had become recently available

- It wasn’t until the first 3 decades of the 20^th century that a recognition of the value of preventative hygienic measures such as handwashing, isolating the sick, boiling milk, and using clean water became widespread

- “Advances in science, diffusion, of knowledge of preventative measures, and improvements in social organization, rather than economic growth per se, appear primarily responsible for the dramatic successes that were to come, both in the US and in much poorer countries.” (p. 207)

Chapter 6

- Despite being the richest country in the world, and having a population that was highly literate and exceptionally well-fed, the US at the turn of the 20^th century had a death rate for children below age 5 that would rank in the bottom quarter of contemporary societies

- One reason for this is that infectious disease processes were poorer understood by public officials, physicians, and parents and the few effective medical technologies that had been developed were slow to diffuse

- Lack of dramatic social class differences in child mortality suggests that a lack of know-how rather than a lack of resources were primarily responsible for child mortality

- Ex: the literate and professionals enjoyed a much smaller mortality advantage than they do today (the mortality of children of doctors was only 6% below the national average)

- Race was the single most important variable in predicting child mortality which suggests that social and economic factors certainly played a role in child mortality, even though growth of income and living standards was not the principal factor causing mortality to decline

- The second most predictive variable was size of place: child mortality much higher in cities than in rural areas

- Suggests that people remained susceptible to natural forces until later in the 20^th century when medical knowledge really expanded

 “Child mortality differences, personal health care practices, and medical technology.”

- Purpose of paper is to examine the role of behavioral factors (as opposed to economic development and public health measures) in changes in child mortality

- Begin with finding that French-Canadians had highest rates of child mortality and Jews had the lowest; why?

- Most likely attributable to differences in childcare, cleanliness, and medical knowledge

            - Diarrheal diseases were the most common cause of child mortality

- In the early 1900s health officials began educating mothers on taking proper care of kids

- Medical experts were unsure about exactly what caused young children and infants to contract diarrhea (was it a direct effect of heat or something caused by heat?)

- Debate over whether or not germs caused disease

- Nevertheless, many of the treatments and precautions recommended to mothers were effective at reducing kids exposure to bacteria, even though medical experts were unaware that this is what was happening

- Areas of advice given to mothers included 1) advice on feeding infants, especially the promotion of hygiene among those who were not breastfeeding, 2) Advice on isolating children from sick family members, 3) advice on handwashing and general hygiene, and 4) advice on when to consult a physician

- Authors conclude that decrease in child mortality was primarily due to advances in disease prevention rather than disease treatment

Danish infants born in June and months around it are more likely to die both as infants and 50+ than those born in other months.

As kids, this makes sense, bad milk -> illness but this is a crictal period that effects whole life.

“Where and why are 10 million children dying every year?” The Lancet, 361, 2226-2234.

Most child deaths are neonatal, then caused by diarrhea and phenmonia

About half (53%) of deaths from all casues are due to being underweight

underwight children are more susceptible to infectious diseases.

88% of child mortality from diarrhea is due to lack of clean water.

- 6 countries account for 50% of all child deaths under 5 years old; 42 countries account for 90%

(India is the highest with 2.4 million childern dying each year)

(Sierra Leone has highest rate of U5MR)

Highest rates in countries with increasing population and decreasing GDP, in Africa, and in places with political instablity.

- Most child deaths occur in sub-Saharan African and South Asia

- Different death rates and causes in different countries mean that different policies should be implemented at the local/national level

- However, lack of data on causes of death in low-income regions can make planning interventions difficult

- Risk factors for child mortality include ingestion of unsafe water, lack of access to sanitation, birth spacing, not being breastfed

- In 42 countries studies, proportions of deaths caused by diarrhea and pneumonia were consistent

- Proportions caused by malaria, AIDS, and deaths in the neonatal period varied greatly

- Diarrhea and pneumonia are leading causes of death in high death rate regimes

- As death rates fall, the proportion of deaths in the neonatal period increases

- Comorbidity of health disorders -> synergistic effect on mortality rates that are higher than the sum of individual rates

 - Ex: being underweight and contracting an infectious disease

“Demographic and socioeconomic impact of AIDS: Taking stock of the empirical evidence.” AIDS, Supplement 2, S1-S7.

Article based on meeting on the Demographic and Socioeconomic Impact of AIDS in Durban, South Africa, March 26-28, 2003

- Most dramatic impact of AIDS on adult mortality 

          - After infection, average person lives 9 years

- Child mortality

            - Increased child mortality among infected mothers

- Family structure

            - Increased orphans and dissolution of infected households

Many reasons make it difficult to assess the socioeconomic impact of AIDS

- Lack of empirical data, too early to tell, lack of data on effects of process of illness

- It is possible that survivors could fare better on the labor market because of decreased labor supply

We have more data on the microeconomic impact of AIDS at the hh level than on the macroeconomic impact at the national level

- Death and sickness affect hh income and assets

- Infected individuals much more likely to live in poverty

“Low levels of maternal education and the proximate determinants of childhood mortality: A little learning is not a dangerous thing.” Social Science and Medicine, 60, 2011-2023.

- Previous research suggests almost perfect inverse linear relationship between maternal education and child mortality

- Authors want to examine whether children of slightly educated mothers are significantly better-off than children of uneducated mothers

- Examine “low levels” of maternal education (some primary school and/or completed primary school) on actual levels and proximate determinants of child mortality

- Use 1992/3 Indian National Family Health Survey

- Find that mothers with low levels of education have a reduced risk of child mortality at 1-24 months compared to illiterate women

- No differences in neonatal mortality

- Low levels of education also leads to better illness management, service utilization, and some health behaviors

- More education has even more beneficial effects, but it appears as though even a little education makes a difference when it comes to child health

Some possible mechanisms

- Research hypothesize that even with only a little schooling, girls learn to respect and obey authority and to follow a routinized program of behavior, which makes them more likely to follow the dictates of health care providers later in life

- Such low levels of education probably not greatly increasing female autonomy

In most African Countries, mothers will even limited eduation have lower infant mortality

Mom's eduation as a proxy for household SES

shows variation in HIV burden.

What explains the rural-urban gap in infant mortality in Africa, household or community characteristics?

In rural 2/3 of increased mortality is due to observed and unobserved hh characteristics

(i.e. safe wather, electricity, quality of housing, finished floors, mom's age, mom's education, birth interval, contraception, birth order)

community characteristics explain 1/4 of gap (2/3 in unobserved hetereogenity and 1/3 observed)

In rural areas IMR is 14%

in Urban 9.6%

 finds grouping of infant mortality is explained by maternal characteristics –

Clustering of deaths in India, within hh more likely to occur multiple deaths characteristic of moms that make them good or bad parents, includes resources, education etc.

 follow up on Das Gupta's study in Kenya re: infant mortality by maternal characteristics

in Kenya using data from the DHS confirm this suggestion

Child mortality determenants

1. environmental

2. mothers characteristics

3. injury/accident/infanticide

4. nutrition

5. personal illness protection (i.e. vaccines)