Читать книгу Demographic Dynamics and Development - Yves Charbit - Страница 25

In the mid-20th century, the rapid decline in mortality spread throughout Latin America and the Caribbean (Table 1.3). In two decades, between 1950–1955 and 1970–1975, life expectancies at birth increased by almost 10 years, and between 1980–1985 and 2000–2005, the increase was 7 years. Over the last period, between 2000–2005 and 2015–2020, the increase was 3 years. Then, during the 1980s, the “lost decade”¹⁶, the progress in mortality slowed down (Table 1.3) due to the Latin American economic crisis. The end of the 2000s also saw a stagnation in mortality, as the health transition now tackles chronic, degenerative diseases and violent causes, in a context of increasing social inequalities, demographic aging and great disparities between cities and rural areas, depending on gender and educational level.

However, over the whole 1950–2020 period, life expectancy at birth increased by 23.8 years (3.4 years per year on average). The infant mortality rate decreased from 126 deaths in 1950–1955 to 59 in 1980–1985, then to 15 deaths of children under the age of 1 per 1,000 births in 2015–2020. Therefore, according to these two indicators, the decline in mortality was particularly swift, reaching 75 years of life expectancy at birth in 2020 for both sexes (Table 1.3).

Table 1.3. Life expectancy at birth and infant mortality in Latin America and the Caribbean: 1950–2020 (sexes combined)

(source: United Nations 2019a, File/Mort 1-1 and Mort 7-1)

	1950–1955	1970–1975	1980–1985	2000–2005	2015–2020
Life expectancy (years)	51.4	61.2	65.3	72.3	75.2
Infant mortality rate (per thousand)	126	80	59	25	15

Between 1950–1955 and 2015–2020, life expectancies at birth converged among nations. Between 1950–1955, the lowest values were 38 years in Haiti and 40 years in Bolivia; the highest, 63 years in Argentina and 66 years in Uruguay: the difference was 28 years between the two extreme values. Between 2015–2020, Costa Rica reached 80 years of life expectancy at birth; Haiti had the lowest value (64 years), which is a 16 years difference between extreme values (Figure 1.1). Spanning seven decades, mortality declined more rapidly in countries with high initial levels (Honduras, Peru and Nicaragua). Bolivia gained 31.5 years of life expectancy at birth, which is considerable from its initial level of 39.6 years. In Mexico, rapid progress has stalled since 2000, following an increase in homicides (Cosio Zavala 2017, pp. 25–27). In Argentina, the increase is steady, whereas Costa Rica has drawn level with and then overtaken Cuba (Figure 1.1).

For Latin America and the Caribbean as a whole, between 2015–2020, female life expectancy at birth (78.5 years) was 6.5 years higher than that of men (72 years). For women, the two extreme values in 1950–1955 were those of Uruguay and Haiti (69 and 39 years, respectively), a difference of 30 years, whereas in 2015–2020, the difference between Costa Rica (83 years) and Haiti (66 years) was 17 years. Among men, in 1950–1955, the difference between extreme values was 27 years (63 years in Uruguay versus 36 years in Haiti), and 16 years in 2015–2020 (77 years in Chile and Costa Rica, and 61 years in Haiti) (United Nations 2019a, Mort/7-2 and 7-3). There is, therefore, a certain convergence in mortality between countries over time, although that of men continues to be higher than that of women.

Between 2015 and 2020, we can classify the mortality of Latin American countries into three groups, based on life expectancy at birth for women, which have the most favorable values:

– In a first group, it exceeds 80 years in Cuba, Argentina and Uruguay, which had low mortality levels since the beginning of the demographic transition¹⁷. This also includes countries that experienced rapid progress in the medical field and in health (Chile, Costa Rica, Panama) and many Caribbean islands in relation to their metropolises (Barbados, Curaçao, Guadeloupe, Martinique, Puerto Rico, Virgin Islands). Infant mortality rates are low within this group: between 4 (Cuba) and 18 (Panama) deaths of children under the age of 1 per thousand births (United Nations 2019a, Mort/7-3).

– The second group is between 75 and 80 years: Brazil, Colombia, Ecuador, Peru, Paraguay, Venezuela in South America; Belize, El Salvador, Guatemala, Honduras, Mexico, Nicaragua in Central America; Antigua, Aruba, Bahamas, Dominican Republic, Jamaica, Saint Vincent and Trinidad and Tobago in the Caribbean. These countries reached 70 years in the late 1980s, except El Salvador, Guatemala, Honduras and Nicaragua, with around 60 years around 1980. But these Central American countries quickly drew level, reaching the values of the second group in the 1990s. Infant mortality rates reached between 15 and 20 deaths of children under the age of 1 per 1,000 births in Venezuela (15), Mexico (17), Peru (18) and Brazil (20); they ranged from 23 to 31 deaths of children under the age of 1 per 1,000 births in Honduras (23) and Nicaragua and Guatemala (31), reflecting poor living conditions and high economic and social vulnerability (United Nations 2019a, Mort/7-3).

– The third group includes four countries, Haiti, Bolivia, Guyana and Suriname, whose female life expectancy at birth is lower than 75 years. These are the poorest countries in Latin America, with many economic and political difficulties, and high social inequality (CEPAL 2019). Infant mortality in Haiti is 64 and in Bolivia it equals 42 deaths of children under the age of 1 per thousand births, which are very high levels (United Nations 2019a, Mort/7-3).

It should be noted that the remarkable progress made in the fight against mortality has been achieved in a coordinated manner. The Pan American Health Organization (PAHO)¹⁸, founded in 1902, has organized medical and sanitation programs in all Latin American countries (installation of drinking water, sewage systems, massive vaccination campaigns, fight against yellow fever, malaria, tuberculosis, measles and other infectious and parasitic diseases). From 1950, they effectively reduced infectious and parasitic mortality, as well as infant mortality, regardless of the population’s living standards, by taking advantage of the discoveries of developed countries. However, during the economic crisis of the 1980s (the lost decade), programs to combat mortality experienced funding restrictions, causing the return of malaria and measles (Cosio Zavala 1998, pp. 39–40). With time, new infectious diseases came into existence, such as AIDS, dengue, Zika, chikungunya and Covid-19.

In 2017, the PAHO declared that in Latin America and the Caribbean, the Millennium Development Goals (MDGs) had all been achieved in 2015, except for MDG5 on maternal mortality. The PAHO is also responsible for monitoring the sustainable development goals (SDGs) in progress, including SDG3 on good health and well-being (PAHO 2017).

Figure 1.1. Female life expectancy at birth per 5-year periods, 1950–2020. LAC (Latin America and the Caribbean) group and selected countries

(source: United Nations 2019a, Mort/7-3). For a color version of this figure, see www.iste.co.uk/charbit/demographic.zip