Determinants and Consequences of Mortality Trends in Ceylon

T HE DEATH RATE in Ceylon declined from 19.8 to 14.0 per 1,000, or 29 percent, in the year from 1946 to 1947. Being most abrupt, this decline in the death rate has given rise to postulations that advances in public health techniques permit significant reductions in the death rate, independently of economic development. Thus, the application of public health measures would increase the rate of population growth and thereby reduce the per capita income, assuming that the birth rate remains constant and economic development lags. Frequently cited (1-5), such postulations may have been accepted as descriptive of the relationship between health and economic development in underdeveloped ereas. However, these hypothetical determinants and consequences of mortality trends in Ceylon are not confirmed by the sequence of events. It was once a,ccepted that control of malaria, through the application of insecticides, was primarily responsible for the postwar reduction in the death rate in Ceylon. This conclusion is not confirmed by the findings that the most precipitous decline in mortality had preceded largescale application of insecticides and that the decline in mortality in the malarious area and the unprotected, nonmalarious area of the island had be-en about the same (6). Indeed, the net demographic effect of malaria control, which has made a major part of the island habitable, may be a reduction in population pressure. The death rate of Ceylon has displayed a long-term downtrend, despite a step-by-step improvement in the reporting of deaths. The downtrend was interrupted in 1935, when a disastrous drought, reisult,ed in a sharp rise in mortality. A semilogarithmic plot of the death rates for 'the quarters of the years since the great drought in 1935 through 1957 indicates a fairly constant rate of decline in the quarterly death rates, with a wartime interruption of the downtrend and a postwar return to the prewar downtrend (fig. 1). It seems the wartime rise in mortality, rather than the postwar decline, may have been the notable event. The wartime rise in mortality suggests that circumstances arising from the war may have exacerbated one of the major public health problems. Malnutrition and malaria have been ranked as the two foremost health problems in Ceylon. Having ruled out malaria control as the primary cause of the postwar decline in mortality, the level of nutrition was examined for fluctuations which may have influenced the death rates to rise during the war and return to the long-term downtrend following the war. It was found that the wartime rise from 1943 to 1946 and the postwar decline in the death rate were associated with the development and alleviation of a wartime food deficit (table 1). The timing and extent of the deficit are indicated by the wartime decline in food imports which represented the principal source of food for Ceylon. The existence of reserves might have delayed any significant effects of the decline in food imports until 1943. Following the war, food imports rose and by 1947 exceeded Dr. Frederiksen is program officer, Division of International Health, Public Health Service, Washington, D.C.