Mortality and Morbidity in Latin America and the Caribbean

Over the past five centuries, mortality and morbidity changes among the people of Afro-Latin America have been closely related to living conditions during the enslavement of Afro-Latin populations, and to their evolving socioeconomic situations after emancipation. High mortality during the slave period was related to many factors, including the length of time of the transatlantic journey and the diseases encountered during the journey; grueling labor conditions; poor housing and nutrition; and waves of epidemic disease that compromised people's health throughout the region. Of the estimated twelve million Africans transported by slave ships to the Americas between the sixteenth and the nineteenth centuries, an estimated 1.5 million died in transit (approximately 12.5 percent per journey, although the mortality rate decreased from 40 percent in the sixteenth century to 5 to 10 percent in the nineteenth century). Transit within the colonies and into new disease environments brought further health risks.

Many enslaved Afro-Latin Americans came to reside in the tropical lowlands of Central and South America and on Caribbean islands. They labored on plantations, in ports, and along rivers where mosquito-related diseases, such as malaria and yellow fever, were prominent. It is frequently argued that Africans were more resistant to smallpox and malaria than Native Americans and Spaniards, but these and other infectious diseases were nonetheless among the leading causes of death among Afro-Latin Americans from the sixteenth century through the nineteenth and into the twentieth century. Afro-Latin Americans also died from yellow fever, typhoid, syphilis, measles, tuberculosis, and pneumonia. Throughout the colonial period, such epidemic outbreaks were frequent although localized; they could occasionally lead to the virtual extinction of entire communities.

Child mortality in such diverse contexts remained severe, particularly for populations of African descent. In the early nineteenth century, for example, Trinidad's slave infant mortality rate was 365 for every 1,000 live births. While it is certain that malnutrition accounted for heavy infant mortality, the exact toll on slave children remains uncertain. In some haciendas in Peru, for example, as many as 45 percent of black children never reached the age of twenty-two. Life expectancy at birth for enslaved peoples in Brazil was twenty-seven years in 1872.

Throughout the nineteenth century, a variety of factors—intense military conflicts and regional wars, trends in urbanization—altered mortality and morbidity patterns for Afro-Latin Americans. The promise of manumission brought many Afro-Latin Americans into the ranks of the patriot and royalist armies in the Spanish American wars, where soldiers fought under poor hygienic conditions, in inhospitable terrain, and where death tolls were high. With nineteenth-century urbanization, new epidemic diseases (cholera and tuberculosis most notoriously) emerged in high-poverty urban areas, resulting in disproportionately heavy mortality among enslaved and freed people who migrated to the cities. In Havana, Cuba, for example, a cholera epidemic in 1835 took the lives of 18,500 black men and women (a death rate 3.5 times higher than whites).

Despite the mortality threats posed by slavery, labor, urbanization, and epidemic disease, between 1700 and the mid-nineteenth century, Afro-Latin Americans witnessed a constant decrease in mortality. Whether the abolition of slavery had any large impact on morbidity and mortality trends remains a topic of debate.

In the twentieth century, high mortality rates associated with epidemics and endemic diseases persisted. The industrial nations of Europe and North America witnessed an "epidemiological transition" from the late nineteenth to the early- to mid-twentieth centuries—a decreasing death toll due to infectious disease and a rising toll due to degenerative and chronic diseases. Such a transition did not define the Central and South American disease experience, however. Where people in the industrial world experienced sharp declines in infant mortality and significant extensions in life expectancy, throughout Latin America this transition began to occur only after World War II. These trends were advanced, in no small part, by the spread of modern health institutions, by improvements in sanitation and hygiene, and by better access to health care for the general population.

Since the mid-twentieth century, Afro-Latin American morbidity and mortality have been linked to differential access to health care, the availability of proper nutrition, and poor hygienic conditions. These factors continue to put the Afro-Latin American populations (from Colombia to the Caribbean, from Haiti to Brazil) at a disadvantage when compared to the nonblack populations in these countries. Although there are differences between nations, the historical pattern of health inequality persists. In Brazil, for example, between 1960 and 1980 Afro-Brazilians could expect to live (on average) seven fewer years than the white population. In the Pacific region of Colombia the infant mortality rate was 191 per 1,000 births in 1993, a rate that surpassed the national average for every year since the 1960s.

Historically and in recent years, Afro-Latin American's mortality and morbidity experience has varied according to the wealth of the country. At one end of the spectrum today, Afro-Uruguayans (a group with good access to health services and making up 6 percent of the nation's population) experience respiratory diseases, asthma, high blood pressure, and diabetes (among the elderly) as their most prominent health problems. At the other end of the spectrum is Haiti, a country experiencing extreme poverty (and where 95 percent of the population claims African descent), which has one of the highest infant mortality rates in the world (95.23 deaths per 1,000 live births in 2001). Haiti's maternal mortality also remains remarkably high at 523 deaths per 100,000 live births. In 2000, life expectancy was forty-two years for Haitian women and forty-three for Haitian men.

The cases of Uruguay and Haiti exemplify the diverse epidemiological challenges faced by Afro-Latin Americans at the turn of the twenty-first century. Many nations of the region today, however, echo both situations. In Honduras, 72 percent of children show signs of malnutrition. In Ecuador, according to UNICEF, the predominant diseases among the black population of the Esmeraldas region are a combination of infectious diseases and chronic degenerative maladies, including malaria, uterine cancer, hypertension, vertigo, sexually transmitted diseases, respiratory problems (from pollution), malnutrition, anemia, cholera, dengue, and typhoid. Throughout the region, the socioeconomic situation of the Afro-Latino populations make them vulnerable to new infectious diseases such as HIV/AIDS and to sexually transmitted diseases. In Brazil and other nations of the region, the incidence of HIV has increased dramatically since the mid-1990s, especially among women. In Haiti, AIDS has become the leading cause of death, followed by tuberculosis, typhoid fever, malaria, and diarrhea.

See also AIDS in the Americas; Race and Science

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carolina giraldo (2005)

keith wailoo (2005)