Health crises: plagues and strikes

Session organizer/s: Nicolas Maughan

A Weakened Society? Plague, Economy and Social Resilience in Early 18th-Century Provence

Session: 7

Authors: Nicolas Maughan

Co-authors: NA

Abstract: Outbreaks of bubonic plague initiated by the flea-borne bacterium Yersinia pestis have repeatedly afflicted the Old World since the onset of the “Justinian Plague” in 541 AD. The second European pandemic, the “Black Death” rapidly killed around half of the population during 1347-1353 AD. Both pandemics then persisted with recurrent local outbreaks over several centuries. The threat from the plague bacillus, which still induces several thousand human cases annually, may well increase under projected climate change. The last major plague in France, the famous “plague of Marseilles”, started in this coastal city and occurred between 1720 and 1722 AD across the South East of France and the Massif Central. The epidemic lasted 31 months and killed about 120.000 people, 240 communities were contaminated. Deaths were not evenly distributed across regions, with some areas affected very little while others were all but entirely depopulated. This was the case for Marseilles with about 50.000 deaths which was frequently called “the dead city”. However, short and long-term global socio-economic impacts of this devastating historical plague outbreak as well as the specific resilience in both the urban and rural populations are not yet fully understood. Understanding how communities respond to abrupt population decline is a key element in both debates about collapse and the identification of putative drivers of social and environmental transformation. A number of quite different outcomes are possible. The plagues of the historical period provide effective case studies of sudden population reduction. Here, we explore the short-term and long-term effects of this epidemic on human populations across the Southeastern France. They include a series of various biological, social, economic, political and religious upheavals which could have profound effects on the course of regional, but also national, history throughout the 18th century. This analysis is a reflection of how the society responded to depopulation - thanks to an adaptive response - with a scaling back of their economy, agriculture, conservation of core functionality, and entrenchment of the established order.

Island Women and the Obesity Transition: Examining SES, Ethnicity and Economic Development

Session: 7

Authors: Anna Tegunimataka (Department of Economic History, Lund University)

Co-authors: Omar Karlsson (Harvard T.H. Chan School of Public Health)

Abstract: Rates of overweight and obesity are increasing rapidly in developing countries due to economic development, decreasing levels of physical activity, and shifting diets and Small Island Developing States (SIDS) tend to have significantly higher obesity prevalence than the global average. This study aims to understand socioeconomic differences in female obesity in different island contexts. Dietary habits and obesity among mothers and pregnant women can affect their offspring, thus affecting the health of younger generations. Female obesity is, therefore, a health concern that extends across generations.

The four countries in the study share characteristics such as remote location, growing and often low-skilled populations, limited land-based resources, small domestic markets, and high dependence on international trade. However, they also represent different levels of economic development and obesity patterns. The Maldives, an upper middle-income country located in the Indian Ocean, has a relatively modest prevalence of female obesity (11.4% in 2016). Samoa, in the Pacific Ocean, is a lower middle-income country with one of the highest prevalence rates of female obesity in the world (55% in 2016). Timor-Leste is also a lower middle-income country but has the lowest prevalence of female obesity of the four (4.9 % in 2016). Fiji, an upper-middle-income country in the Pacific Ocean, has a more ethnically diverse population and a lower prevalence of female obesity than other countries in the Pacific Ocean (35% in 2016).

The relationship between socioeconomic status (SES), economic development, and obesity is complex. In lower-income countries, higher SES groups are more likely to be obese, while in high-income countries, those with higher SES are less likely to be obese. Economic development can lead to improvements in health, but it can also lead to overconsumption, which affects SES groups differently.

The study draws upon two data sources: the Multi-Indicator Cluster Survey (MICS) for Fiji and Samoa, and the Demographic and Health Survey (DHS) for the Maldives and Timor-Leste. The variables in the two data sources are highly comparable.

The preliminary regression results indicate that in the Maldives, there is a clear SES gradient in obesity, with the lowest SES group (those with primary or lower education) having the highest odds of being obese. This is a pattern commonly observed in high-income countries. In contrast, in Samoa and Timor-Leste, those with higher levels of education have higher odds of obesity. This is a common pattern in many developing countries at the early stages of the obesity transition. The Fijian patterns do not follow the other countries, as the associations change when control variables are added. Crude estimates show the highest obesity among those least educated, while adjusted estimates. The Fijian results also hide a story of ethnic differences as they play a crucial role in explaining SES patterns in obesity.

The Effect of Strikes on Health

Session: 7

Authors: Nikolaos Prodromidis

Co-authors: NA

Abstract: This paper examines the health effects of labor strikes in Sweden during the early 20th century. Worker-employer disagreements over wages and working conditions often resulted in work stoppages in the form of strikes, and Sweden experienced a significant number of strikes during this period, making it one of the world’s leaders in industrial disputes [Korpi and Shalev, 1979]. By studying the health impacts of these strikes, this research aims to shed light on the consequences of labor disputes for workers and their families. While strikes are a common form of labor dispute, limited research has been conducted about their potential health effects. Specifically, this study investigates whether strikes led to changes in mortality measures. To estimate the causal effect of strikes on health, this study uses a unique historical quasi-experiment: the staggered adoption of strikes across Sweden between 1908 and 1927. I exploit the time-parish variation of the strikes and estimate staggered difference-in-differences models and event studies. The identification strategy relies on the exogenous variation of the time of the strike, assuming that the exact date of the strike is exogenous and not influenced by the mortality patterns in the parish. Sensitivity analyses are conducted to evaluate the validity of the identification strategy. This study contributes to the literature on the relationship between strikes and health by examining strikes across various work sectors, in contrast to previous studies that focused exclusively on transportation or healthcare sectors [Gruber and Kleiner, 2012; Adda, 2016; Bauernschuster et al., 2017; Karlsson and Schwarz, 2021; Hirani et al., 2022; Costa, 2022; Friedman et al., 2022]. The research uses administrative reports to identify the strikes, which provide rich background information on the exact date, place, and causes of the strikes [Enflo and Karlsson, 2019; Molinder et al., 2021, 2022]. Mortality measures are derived from administrative sources that cover the entire population. In addition, digitized individual-level death certificates from 1918 to 1920 with cause-of-death are used. The study also uses linked data from the 1900 and 1910 Censuses to provide information on important demographic and socioeconomic indicators. The study finds that strikes during the Great Influenza Pandemic increased the mortality rate in the subsequent weeks. Compared to a baseline weekly mortality rate of 0.3 per 1,000 population, strikes during the pandemic resulted in a 16 percent increase in the weekly mortality rate, which translates to an estimated 750 additional deaths over the course of the pandemic. This finding is driven by influenza-related deaths among the workers. The study finds that these effects emerged in areas without containment measures (such as gathering bans) in place, providing support for the idea that the mass gatherings associated with the strikes propagated respiratory disease transmission. However, strikes outside of periods of elevated disease prevalence do not appear to have a significant effect on mortality. By examining the health effects of labor strikes in Sweden during the early 20th century, this study makes a novel contribution to our understanding of the complex relationship between employment and health.