Determinantes económicas y sociales de la mortalidad en América Latina / Economic and social determinants of mortality in Latin America

Se sostiene la tesis de que no pudiendo negarse las causas biológicas de las diferenciales de la mortalidad, las causas sociales pueden desencadenar y aun transformar los factores biológicos de éstas. Se sostiene asimismo, que el fenómeno salud-enfermedad alnivel colectivo tiene una determinación social y debe ser estudiado en el marco de una teoría social. En ésta concepción la raíz del proceso está en la forma en que el hombre se apropia y transforma los recursos naturales y en la relaciones que para esto establece con otros hombres, para apropiarse del producto generado. Este proceso social varía según la formación economicosocial en que se produzca. Al estudiar América Latina se pone en evidencia lo decisiva que en la formación economicosocial predominante en esta región el capitalismo resulta la clase social en que se insertan los sujetos objetos de estudio como determinante de diferenciales de mortalidad (AU)

[Economic and social determinants of mortality in Latin America]. / Determinantes economicas y sociales de la mortalidad en America Latina.

PIP: It is estimated that more than half of the infants born in Latin America are exposed to a mortality rate higher than 120/1000. Social indicators, such as number of hospital beds, protein consumption, literacy level, and type of housing are highly related to life expectancy at birth. More important yet is the relation of mortality with the socioeconomic characteristics of a given country within Latin America. Geographical differences of mortality are the result of national policies especially in regard to urban and rural population. For example, probability of death in Ecuador is 98/1000 in urban areas, and 145/1000 in rural areas; data are similar for other countries. The socioeconomic contradictions of the capitalist system create differences in mortality rates by concentrating in the few cities most of the health services, and by providing better living conditions for the urban population. Mortality, especially infant, is inversely related to income and to educational status and age of the mother. The many indigenous ethnic groups still existing in many Latin American countries have even higher mortality rates than the rest of the population. Respiratory dysfunctions, infectious diseases, malnutrition and accidents are the main causes of infant mortality in all groups of people, but with much higher rates for the working classes, and lower rates for the higher income classes. As a final analysis, not only is it important to use modern medical knowledge and technology to lower mortaltiy rates, but, and above all, it is imperative to modify social and economic structures.^ieng

[Socioeconomic differentials in the decline of fertility in Costa Rica, 1960-1970 (author's transl)]. / El descenso de la fecundidad en Costa Rica y sus diferencias socioeconomicas, 1960-1970.

PIP: Principal source for investigation on fertility are birth registrations, a source which is very often deficient by omission in Latin America. This situation has prompted the development of more specific methods which use other, and more reliable, information. One of these is the own-children method, which allows estimations based on population censuses. This article presents an investigation on the process of fertility decline in Costa Rica between 1960 and 1970, using the own-children method applied to data from the 1973 census. Costa Rica was selected to evaluate this method since the country's birth registers are relatively reliable. Total fertility rate was higher than that estimated through birth registration; in certain rural regions it was 10-15% higher, possibly because, in those particular regions, omission of birth registration was higher than the national level. Towards the end of the 1950s, half of the women in fertile age were using contraception; the decline in fertility began in the middle and high social classes, and in urban areas. Later, at the end of the 1960s, the decline in fertility reached urban proletarian groups, and the illiterate rural population. It seems obvious that these fertility changes are due to the insertion of families into the system of production, meaning that modernization and education have created a climate favorable to smaller families. These findings are consistent with available information on changes of attitude toward family planning, heavily promoted by the National Family Planning Program begun in 1968. In 1970 the steepest decline in fertility was noted in those groups which, despite the decline, still had the highest fertility rate; by 1977 a tendency toward stabilization was registered.^ieng

[Infant and child mortality in Latin America].

PIP: High mortality rates persist in Latin America, and data collection is made very difficult because of the lack of reliable statistics. A study was initiated in 1976 to measure the probability of mortality from birth to 2 years of age in 12 Latin American countries. The Brass method was used and applied to population censuses. Probability of mortality is extremely heterogeneous and regularly very high, varying between a maximum of 202/1000 in Bolivia, to a minimum of 112/1000 in Uruguay. In comparison, the same probability is 21/1000 in the U.S., and 11/1000 in sweden. Mortality in rural areas is much higher than in urban ones, and varies according to the degree of education of the mother, children being born to mothers who had 10 years of formal education having the lowest risk of death. Children born to the indigenous population, largely illiterate and living in the poorest of conditions, have the highest probability of death, a probability reaching 67% of all deaths under 2 years. National health services in Latin America, although vastly improved and improving, still do not meet the needs of the population, especially rural, and structural and historical conditions hamper a wider application of existing medical knowledge.^ieng