Germs and Jim Crow: The Impact of Microbiology on Public Health Policies in Progressive Era American South

Race proved not merely a disadvantage in securing access to prompt and appropriate medical care, but often became a life and death issue for blacks in the American South during the early decades of the twentieth century. This article investigates the impact some of the new academic disciplines such as anthropology, evolutionary biology, racially based pathology and genetics had in promoting scientific racism. The disproportionately high morbidity and mortality rates among blacks were seen as a consequence of inherent racial deficiencies that rendered any attempt to ameliorate their situation as futile. While the belief in a different pathology in blacks initially deterred most health officials from taking any action, advances in medicine and microbiology, in particular the germ theory, stirred a variety of responses out of sheer self preservation, as fears among whites at the first sign of an epidemic initiated sporadic and limited actions. Ironically, in an era of deepening scientific racism, public health initiatives based on a better understanding of disease causing microorganisms, gradually improved black health. However, some public health measures were hijacked by eugenicists and racists and, rather than addressing the ill health of blacks, public health policy complied with the new laws of heredity by promoting drastic measures such as involuntary sterilization or even abortion. This further complicated the strained relationship between southern blacks and health care professionals and effected ongoing distrust towards public healthcare services.     

Regression analysis of recent changes in cardiovascular morbidity and mortality in The Netherlands.

OBJECTIVES: To test whether recent declines in mortality from coronary heart disease were associated with increased mortality from other cardiovascular diseases. DESIGN: Poisson regression analysis of national data on causes of death and hospital discharges. SETTING AND SUBJECTS: Population of the Netherlands, 1969-93. MAIN OUTCOME MEASURES: Annual changes in mortality from coronary heart disease, stroke, and other cardiovascular diseases and annual changes in hospital discharge rates for acute coronary events, stroke, and congestive heart failures. RESULTS: Patterns of cardiovascular mortality changed abruptly in 1987-93. Annual decline in mortality from coronary heart disease increased sharply for women and men: from -1.9% (95% confidence interval -2.2% to -1.6%) and -1.7% (-1.9% to -1.4%) respectively in 1979-86 to -3.1% (-3.5% to -2.6%) and -4.2% (-4.6% to -3.9%) in 1987-93. The longstanding decline in mortality from stroke levelled off: from annual change of -3.3% (-3.7% to -2.8%) and -3.2% (-3.7% to -2.8%) in 1979-86 to -0.1% (-0.7% to 0.4%) and -1.1% (-1.7% to -0.5%) in 1987-93. Mortality from other cardiovascular diseases, however, started to increase: from -2.0% (-2.4% to -1.6%) and -0.2% (-0.5% to 0.2%) in 1979-86 to 1.5% (1.0% to 2.0%) and 1.9% (1.5% to 2.3%) in 1987-93. Hospital discharge rates for acute coronary heart disease, congestive heart failure, and stroke increased during 1980-6. During 1987-93 discharge rates for stroke and coronary heart disease stabilised but rates for congestive heart failure increased. CONCLUSION: Improved management of coronary heart disease seems to have reduced mortality, but some of the gains are lost to deaths from stroke and other cardiovascular diseases. The increasing numbers of patients with coronary heart disease who survive will increase demands on health services for long term care.     

Adverse Trends in Ischemic Heart Disease Mortality among Young New Yorkers,Particularly Young Black Women

Background

Ischemic heart disease (IHD) mortality has been on the decline in the United States for decades. However, declines in IHD mortality have been slower in certain groups, including young women and black individuals.

Hypothesis

Trends in IHD vary by age, sex, and race in New York City (NYC). Young female minorities are a vulnerable group that may warrant renewed efforts to reduce IHD.

Methods

IHD mortality trends were assessed in NYC 1980–2008. NYC Vital Statistics data were obtained for analysis. Age-specific IHD mortality rates and confidence bounds were estimated. Trends in IHD mortality were compared by age and race/ethnicity using linear regression of log-transformed mortality rates. Rates and trends in IHD mortality rates were compared between subgroups defined by age, sex and race/ethnicity.

Results

The decline in IHD mortality rates slowed in 1999 among individuals aged 35–54 years but not ≥55. IHD mortality rates were higher among young men than women age 35–54, but annual declines in IHD mortality were slower for women. Black women age 35–54 had higher IHD mortality rates and slower declines in IHD mortality than women of other race/ethnicity groups. IHD mortality trends were similar in black and white men age 35–54.

Conclusions

The decline in IHD mortality rates has slowed in recent years among younger, but not older, individuals in NYC. There was an association between sex and race/ethnicity on IHD mortality rates and trends. Young black women may benefit from targeted medical and public health interventions to reduce IHD mortality.     

Rapid population declines of Egyptian vulture (Neophron percnopterus) and red-headed vulture (Sarcogyps calvus) in India

Since the early 1990s, large and rapid population declines of three species of vulture ( Gyps spp.) endemic to south Asia have occurred on the Indian subcontinent and have led to these species being listed by IUCN as critically endangered. Evidence of rates of population decline, cause of death and toxicity is consistent with these declines being caused by poisoning of vultures through the ingestion of tissues from livestock treated with the anti-inflammatory drug diclofenac. In this paper, analysis of repeated surveys in and near protected areas widely spread across India shows that populations of two other vulture species, Egyptian vulture Neophron percnopterus and red-headed vulture Sarcogyps calvus , have also declined markedly and rapidly, but probably with a later onset than Gyps vultures in the same region. The declines continued at least up to 2003. It is recommended that these two species are considered for inclusion in the IUCN Red List and for urgent remedial conservation measures. Research is needed to determine whether or not the principal cause of these declines is diclofenac poisoning and to establish population trends in other scavenging birds in the Indian subcontinent.     

Linking global warming to amphibian declines through its effects on female body condition and survivorship

There is general consensus that climate change has contributed to the observed decline, and extinction, of many amphibian species throughout the world. However, the mechanisms of its effects remain unclear. A laboratory study in 1980–1981 in which temperate zone amphibians that were prevented from hibernating had decreased growth rates, matured at a smaller size and had increased mortality compared with those that hibernated suggested one possible mechanism. I used data from a field study of common toads (Bufo bufo) in the UK, between 1983 and 2005, to determine whether this also occurs in the field. The results demonstrated two pathways by which global warming may cause amphibian declines. First, there was a clear relationship between a decline in the body condition of female common toads and the occurrence of warmer than average years since 1983. This was paralleled by a decline in their annual survival rates with the relationship between these two declines being highly correlated. Second, there was a significant relationship between the occurrence of mild winters and a reduction in female body size, resulting in fewer eggs being laid annually. Climate warming can, therefore, act on wild temperate zone amphibians by deleteriously affecting their physiology, during and after hibernation, causing increased female mortality rates and decreased fecundity in survivors.     

Demographic and health status risk factors in childbearing among Indian women. Evidence from hospital data for the later stages of fertility decline

Indirect estimates of maternal mortality in India indicate that fertility decline has reduced maternal deaths by reducing the frequency of pregnancy and childbirth. The earlier stages of fertility decline are also likely to have lowered maternal mortality by reducing the risk of pregnancy and childbirth as the proportion of births among risky multiparous, older women declines. However, further fertility decline may well be associated with some increase in risk. Risk will also remain high if the health status of Indian girls and women remains poor. This study uses a sample of maternal deaths and deliveries among patients who survived which occurred in Civil Hospital, Ahmedabad, Gujarat during 1982-1993 to investigate these issues further. The women in the sample have relatively low fertility and represent a fairly late stage of fertility decline. They also have persistently poor health status. Logit regression analysis reveals that although fertility decline is associated with some increase in risk, poor health status is the more important maternal mortality risk factor. Without attention to female health, even childbearing among expectant mothers with low fertility continues to be hazardous.     

Cardiovascular disease mortality in Canada.

During the past two decades approximately one half of all deaths in Canada were due to cardiovascular diseases. Ischemic heart disease and cerebrovascular disease caused more than 60% and 20% of those deaths respectively. The mortality rates for ischemic heart disease in males increased slightly until 1965 and then dropped substantially, whereas the rates for females, which were declining at least since the early 1960s, accelerated in their decline. As a consequence, the rates for males remain almost twice as high as those for females. The reductions were initially observed in males 25 to 34 years old and in all age groups of females, but became apparent in a wider range of ages in the second period reviewed (1969 through 1977). The mortality of cerebrovascular disease has gradually diminished for both sexes since the 1950s, but the decline has been more pronounced among females, who originally had the higher rate. Marked geographic differences in mortality rates still exist in Canada despite the decline in death rates for both ischemic heart disease and cerebrovascular disease in all regions of the country. Surprising regional differences in times of onset of these declines have been demonstrated. For ischemic heart disease Ontario maintains the highest and the Prairies the lowest mortality rates. Quebec, despite a sustained decline, still ranks third, while the Pacific region shows the second-lowest rates in the country. The Atlantic region showed the lowest rates of decline in the period reviewed. The reduction in the mortality of ischemic heart disease in Canada (16.4% between 1969 and 1977) must be considered real for a variety of reasons. Direct evidence is not available to elucidate whether the reduction is the consequence of reduced incidence, increased survival or a combination of the two factors. The potential role of various factors that may have contributed to this decline is briefly discussed in this article.     

Trends in perinatal mortality attributed to congenital malformations in England and Wales during 1974-81: a study of the variations among regional health authority areas

Analysis of perinatal mortality attributed to congenital malformations in England and Wales, using data from birth and death registration over the years 1974-81 showed significant declines in England and Wales as a whole and in the individual Regional Health Authority (RHA) areas. A greater decrease in death rate from congenital malformations, particularly central nervous system malformations, was seen among stillbirths than among early neonatal deaths. There were marked regional differences in perinatal mortality due to central nervous system malformations over the period but not in cardiovascular system malformations or in other malformations. The highest mortality rates due to central nervous system malformations occurred in the North, North-West, West and South-West of England and in Wales, and the lowest rates in the South and South-East. The larger percentage reductions in the mortality rates were found in most of the regions which had had the highest rates. Possible explanations for the decline in regional rates are suggested.     

A bitter epidemic: The impact of the 1918 influenza on sugar production in Java

Research about the economic consequences of past epidemics has mostly focused on the experience of industrialized countries, thus providing little knowledge about the effects of health shocks on developing economies. We fill this gap by studying the impact of the 1918 influenza in Java, with a new dataset on aggregate food production and district-level figures on (i) sugar production, the major export commodity and the predominant source of labour demand; (ii) agricultural and plantation wages, and (iii) annual crude death rates. The mortality impact of the influenza on Java was high, as crude mortality rates doubled in 1918 relative to the preceding years, but its economic impact was mixed. Aggregate food production did not decline, but sugar output did fall in 1919. Indeed, our regional panel data analysis does not establish a direct relationship between regional epidemic mortality variation and sugar output decline. Instead, we hypothesize that economic activity was rediverted towards food production in order to avoid famine that could have resulted from the combined effects of disrupted shipping at the end of the First World War, climatic conditions and the public health crisis. This is supported by both qualitative observations and quantitative evidence suggesting that those regions that were highly suitable for rice production saw a larger reduction in sugar production, and that in regions that had more flexibility in land tenure arrangements experienced substantially greater reductions in sugar output.     

Regional variations and trends in mortality from cardiovascular diseases in population aged 0-64 in Dalmatia and Slavonia, 1998-2009

The aim of this paper was to analyse the regional variations and trends in mortality from cardiovascular diseases in the population aged 0-64 years in Dalmatia and Slavonia, over the period 1998 to 2009. Mortality data were derived from Central Bureau of Statistics. The results show that age-standardized mortality rates from total cardiovascular diseases, ischaemic heart diseases and cerebrovascular diseases were lower in Dalmatia than rates for Slavonia, for both genders. All mortality rates, except rates for ischaemic heart diseases mortality for men in both regions, showed the trend of decline. Dalmatia has a more protective factors in pattern of Mediterranean diet. The improvement of cardiovascular health and reduction of premature mortality from cardiovascular diseases requires a system and comprehensive intervention approach at all levels of health care and multisectorial coordination.     

Health transition: examples from the western Pacific.

The Industrial Revolution ushered in a rapid transition from agriculture to industrialization. Some biological effects of this transition included increasing life expectancy, reduced infant mortality, and some decline in fertility. Reduced infant mortality first brought about an increase in life expectancy, but as humans were able to control infectious diseases, child and adult mortality also decreased. Now, accidents and chronic diseases are responsible for most mortality in many age groups. This shift from infectious diseases to accidents and chronic diseases is called the health transition. Japan and US are Pacific Basin countries which have relatively high life expectancy and low infant mortality (1988, 75.54 years vs. 71.38 years, and 4.4 vs. 9.9, respectively). These figures suggest that these countries rather advanced in the health transition. Japan may have better life expectancy than the US because of the effect of environmental factors, ethnic diversity, and health care differentials by social class on cardiovascular disease and cancer mortality. China and Thailand hold intermediate positions (67.98 years (1985-1990) vs. 63.82 years (1985-1986), and 32.4 vs. 39, respectively). Some research indicates that urban conditions and factory work increase the cardiovascular disease risk among the Chinese. Recent research suggests that access to immunization and modern medical care for acute disease are the only critical variables of the health transition rather than other variables. Papua New Guinea is not progressing very well (53.18 years and 58). Papua New Guinea has not yet been able to control infectious diseases, especially malaria. This comparison illustrates that populations progress through the health transition at different rates.     

The Huge Reduction in Adult Male Mortality in Belarus and Russia: Is It Attributable to Anti-Alcohol Measures?

Background and Aim

Harmful alcohol consumption has long been recognized as being the major determinant of male premature mortality in the European countries of the former USSR. Our focus here is on Belarus and Russia, two Slavic countries which continue to suffer enormously from the burden of the harmful consumption of alcohol. However, after a long period of deterioration, mortality trends in these countries have been improving over the past decade. We aim to investigate to what extent the recent declines in adult mortality in Belarus and Russia are attributable to the anti-alcohol measures introduced in these two countries in the 2000s.

Data and Methods

We rely on the detailed cause-specific mortality series for the period 1980–2013. Our analysis focuses on the male population, and considers only a limited number of causes of death which we label as being alcohol-related: accidental poisoning by alcohol, liver cirrhosis, ischemic heart diseases, stroke, transportation accidents, and other external causes. For each of these causes we computed age-standardized death rates. The life table decomposition method was used to determine the age groups and the causes of death responsible for changes in life expectancy over time.

Conclusion

Our results do not lead us to conclude that the schedule of anti-alcohol measures corresponds to the schedule of mortality changes. The continuous reduction in adult male mortality seen in Belarus and Russia cannot be fully explained by the anti-alcohol policies implemented in these countries, although these policies likely contributed to the large mortality reductions observed in Belarus and Russia in 2005–2006 and in Belarus in 2012. Thus, the effects of these policies appear to have been modest. We argue that the anti-alcohol measures implemented in Belarus and Russia simply coincided with fluctuations in alcohol-related mortality which originated in the past. If these trends had not been underway already, these huge mortality effects would not have occurred.     

Mortality and displaced mortality during heat waves in the Czech Republic

The aims of this study were to assess impacts of hot summer periods on mortality in the Czech Republic and to quantify the size of the short-term displacement effect which resulted in lower than expected mortality after heat waves. The analysis covered the period 1982–2000 when several extraordinarily hot summers occurred in central Europe. Daily total all-cause mortality and mortality due to cardiovascular diseases (CVD) in the entire population of the Czech Republic (approximately 10 million inhabitants) were examined. The daily death counts were standardized to account for the long-term decline in mortality and the seasonal and weekly cycles. Heat-related mortality is better expressed if 1-day lag after temperature is considered compared to the unlagged relationship. With the 1-day lag, both excess total mortality and excess CVD mortality were positive during all 17 heat waves, and in 14 (12) heat waves the increase in total (CVD) mortality was statistically significant (P=0.05). The mean relative rise in total mortality during heat waves was 13%. The response was greater in females than males and similar regardless of whether total or CVD mortality was used. The largest relative increases, exceeding 20% in both total and CVD mortality, were associated with heat waves which occurred in early summer (the first half of July 1984 and June 1994). The mortality displacement effect played an important role since mortality tended to be lower than expected after hot periods. The mean net mortality change due to heat waves was estimated to be about a 1% increase in the number of deaths. The large relative increases during some heat waves were particularly noteworthy since the study (in contrast to most analyses of the heat stress/mortality relationship) was not restricted to an urban area and/or an elderly population.     

Mortality differentials in Canada, 1951–1971: French,British, and Indians

Mortality differentials reflect in part the social and economic conditions of groups in society. In this paper, the relationship between ethnic origin and mortality is investigated from the point of view of convergence and minority group status hypotheses. Multivariate methods are used to study differences among the French, the British and Native Indian (includes Metis and Eskimos) populations of Canada over three census periods from 1951 to 1971. A significant downward trend in the death rates of all three subpopulations is noted, but substantial differences persist, as the pace of mortality decline over time varies across the three ethnic groups. In the twenty-year interval between 1951 and 1971, Native Indians have experienced spectacular reductions in their overall death rates, but in comparative terms, their mortality levels still exceed those of the French (who show intermediate levels) and the British ethnic groups. The multivariate analysis provides strong support for the minority status effect, which is taken to suggest that the roots of inequalities in survival probabilities are partly a result of social and economic disparities. The convergence thesis received some support: over time the general pattern is one of declining mortality with some narrowing of the differences. An examination of four broad causes of death (neoplasms, cardiovascular, accidents-violence, and "other") suggests that Native Indians are characteristic of populations undergoing epidemiologic and demographic transitions. Their elevated risk of accidents-violence reflects social disruption in the process of modernization. Causes of death of the French and British populations are characterized by higher risks of cancer and cardiovascular diseases, typical of advanced societies.     

Health and social inequality in Europe.

In most European countries health has been shown to be linked to social circumstances--gradients in health status have persisted for decades, despite major changes in the principal causes of death. In central and eastern Europe life expectancy has stagnated since the mid-60s, whereas in the West it has increased; but even in the West it is related to income distribution. Social differences in mortality in men are three times as large in some countries as in others, and are influenced by factors other than conventional risk factors. Substantial declines in mortality and morbidity could result from a narrowing of health inequalities even when differences in health risk between social groups are comparatively small. Policies to reduce health inequalities can be introduced in smaller communities and organisations such as the school and workplace. National policies are variable; factors generating inequalities require action across several policy areas.     

Continuing decline of a keystone tree species in the Kruger National Park,South Africa

Sclerocarya birrea subsp. caffra (marula), a keystone large tree species in southern Africa and heavily utilized by people and herbivores, is declining at an unprecedented rate in the Kruger National Park (KNP), South Africa. Due to increasing concerns over large tree declines in the KNP, mirroring those in eastern Africa over the last 50 years, and local extinctions of marula populations in the north‐western KNP, adult trees in the southern KNP were monitored between 2001 and 2010. Annual mortality rates across all adult size classes ranged between 3.2 and 4.6%. Loss of adult marula trees in some areas over the last decade exceeded 25%. Rainfall had a strong influence on mortality rates temporally and spatially, but the distance to the nearest perennial river had little influence. Overall, marula populations continue to decline and further local extinctions are possible. Given the clearly unacceptable trends of decline, the next step is to utilize this information (i) to develop predictive models for the future dynamics of marula populations incorporating all drivers; (ii) to advocate active management of refugia within the park where marula populations are protected from elephant impacts; and in combination with (iii) continued monitoring.     

Decadal changes in summer mortality in U.S. cities

Recent studies suggest that anthropogenic climate warming will result in higher heat-related mortality rates in U.S. cities than have been observed in the past. However, most of these analyses assume that weather-mortality relationships have not changed over time. We examine decadal-scale changes in relationships between human mortality and hot, humid weather for 28 U.S. cities with populations greater than one million. Twenty-nine years of daily total mortality rates, age-standardized to account for underlying demographic changes, are related to afternoon apparent temperatures ( T(a)) and organized by decade for each city. Threshold T(a) values, or the T(a) at and above which mortality is significantly elevated, are calculated for each city, and the mortality rates on days when the threshold T(a) was exceeded are compared across decades. On days with high T(a), mortality rates were lower in the 1980s and 1990s than in the 1960s and 1970s in a majority of the cities. Regionally, northeastern and northern interior cities continue to exhibit elevated, albeit reduced, death rates on warm, humid days in the 1980s and 1990s, while most southern cities do not. The overall decadal decline in mortality in most cities is probably because of adaptations: increased use of air conditioning, improved health care, and heightened public awareness of the biophysical impacts of heat exposure. This finding of a more muted mortality response of the U.S. populace to high T(a) values over time raises doubts about the validity of projections of future U.S. mortality increases linked to potential greenhouse warming.     

Neuronal‐specific proteasome augmentation via Prosβ5 overexpression extends lifespan and reduces age‐related cognitive decline

Cognitive function declines with age throughout the animal kingdom, and increasing evidence shows that disruption of the proteasome system contributes to this deterioration. The proteasome has important roles in multiple aspects of the nervous system, including synapse function and plasticity, as well as preventing cell death and senescence. Previous studies have shown neuronal proteasome depletion and inhibition can result in neurodegeneration and cognitive deficits, but it is unclear if this pathway is a driver of neurodegeneration and cognitive decline in aging. We report that overexpression of the proteasome β5 subunit enhances proteasome assembly and function. Significantly, we go on to show that neuronal‐specific proteasome augmentation slows age‐related declines in measures of learning, memory, and circadian rhythmicity. Surprisingly, neuronal‐specific augmentation of proteasome function also produces a robust increase of lifespan in Drosophila melanogaster. Our findings appear specific to the nervous system; ubiquitous proteasome overexpression increases oxidative stress resistance but does not impact lifespan and is detrimental to some healthspan measures. These findings demonstrate a key role of the proteasome system in brain aging.     

Socioeconomic development and mortality levels in less developed countries

Abstract

Some demographers have argued that post‐World War II mortality declines in the less‐developed countries (LDC's) are not associated with economic and social development because of the diffusion of health and medical techniques from the developed to the underdeveloped countries. This paper examines the current relationship between socioeconomic development and mortality levels in 124 countries, 94 of which are LDC's. The argument is tested with a path model consisting of five multidimensional and three unidimensional indicators. Results indicate that for the LDC's, there is a very strong set of direct and indirect relationships between indicators of socioeconomic development and mortality. Between 62 and 80 per cent of the variances in the crude death rate, infant mortality, and life expectancy are explained in the LDC model. The empirical test of the model demonstrates that lower mortality levels in the LDC's are dependent on socioeconomic factors and health services; continued improvement of socioeconomic levels in the LDC's will result in further mortality declines. For comparative purposes, the same model also is tested for more developed countries. Results for the model with more developed countries (MDC's) show that entirely different measures are necessary for MDC mortality models; the concept of “mortality” for LDC's and MDC's is orthogonal and requires different empirical indicators.     

Trends in Health--Ecological Consequences for the Human Population

Rapid health changes in the U.S. and other industrialized nationsof the world during the twentieth century are being roughlyparalleled in the developing nations, some decades later. Thesechanges include the reduction of communicable diseases, a strikingdecrease in infant mortality and lower death rates through theage-span, and the emergence and decline of the "modern" epidemicssuch as coronary heart disease. Increase in life expectancyat birth and at age 65 is one immediate and already measurableimpact of these trends. Making several assumptions about thefuture health of mankind, such as no devastating virus diseaseepidemics and no further nuclear warfare, one can project threeconsequences of the health trends described: (1) an almost verticalage-structure of the population, rather than the previous andpresent pyramidal shape; (2) greater social and individual attentionto maintaining health, beyond combatting major diseases; and(3) gradual dissolution of the barriers to association amongthe peoples of the world.