Jean-Hervé Bradol & Jean-Hervé Jézéquel
Medical doctor, specialized in tropical medicine, emergency medicine and epidemiology. In 1989 he went on mission with Médecins sans Frontières for the first time, and undertook long-term missions in Uganda, Somalia and Thailand. He returned to the Paris headquarters in 1994 as a programs director. Between 1996 and 1998, he served as the director of communications, and later as director of operations until May 2000 when he was elected president of the French section of Médecins sans Frontières. He was re-elected in May 2003 and in May 2006. From 2000 to 2008, he was a member of the International Council of MSF and a member of the Board of MSF USA. He is the co-editor of "Medical innovations in humanitarian situations" (MSF, 2009) and Humanitarian Aid, Genocide and Mass Killings: Médecins Sans Frontiéres, The Rwandan Experience, 1982–97 (Manchester University Press, 2017).
Deputy Project Director for West Africa at International Crisis Group.
Jean-Hervé Jézéquel first worked as a Consultant for Crisis Group in Guinea in 2003, before joining as the Senior Analyst for the Sahel region in March 2013. He has also worked as a Field Coordinator in Liberia, a West Africa Researcher and a Research Director, for Médecins sans Frontières.
There is a plethora of social science literature on hunger and malnutrition. The list provided below is both partial and discriminating. Only the main reading material used for drafting this Cahier is included.
ATKINS P. J. (1992), ‘White Poison?: The social consequences of milk consumption, 1850-1930’, Society for the Social History of Medicine, pp.207-27.
This paper seeks to adduce evidence on the social consequences of milk consumption in the period 1850–1930. It is shown that the poor quality of supply partly resulted from the nature of the marketing system, with adulteration and the use of chemical preservatives as other factors. Local authority regulation and central government legislation were very slow in controlling the cleanliness of production and sale. Milk was heavily contaminated with bacteria and was responsible for spreading a variety of diseases such as scarlet fever and tuberculosis. Infants not wholly breastfed were particularly vulnerable to diarrhoeal infections. Improvements such as pasteurization and bottling were slow to spread and are unlikely to have had much impact before the 1920s. Overall it is argued that ill-health caused by dirty milk was more serious, and its amelioration much later than previously documented.
BADO J.P. (1996), Médecine coloniale et grandes endémies, Paris, Karthala. No abstract available.
BANISTER J. & HILL K. (2004), ‘Mortality in China 1964-2000’, Population Studies, Vol. 58, no. 1, pp. 55-75.
This paper uses data from censuses and surveys to re-estimate mortality levels and trends in China from the 1960s to 2000. We use the General Growth Balance method to evaluate the completeness of death reporting above the youngest ages in three censuses of the People’s Republic of China from 1982 to 2000, concluding that reporting quality is quite high, and revisit the completeness of death recording in the 1973-75 Cancer Epidemiology Survey. Estimates of child mortality from a variety of direct and indirect sources are reviewed, and best estimates arrived at. Our estimates show a spectacular improvement in life expectancy in China: from about 60 years in the period 1964-82 to nearly 70 years in the period 1990-2000, with a further improvement to over 71 years by 2000. We discuss why survival rates continue improving in China despite reduced government involvement in and increasing privatization of health services, with little insurance coverage.
BELL F. & MILLWARD R. (1998), ‘Public Health Expenditures and Mortality in England and Wales 1870-1914’, Continuity and Change, 13(2).
Attempts to account for the pattern and progress of mortality decline in England and Wales in the nineteenth century have produced a literature in which something of a general accord exists over key factors involved. Historians acknowledge the influence of two broad trends of change: environmental improvements as a result of sanitary reform initiatives and nutritional improvements as a consequence of a rise in the general standard of living. Where discord has arisen is in the degree of attachment of individual historians to one or other of these trends as primary contributor. The study of mortality decline, which was the product of a complex amalgam of factors, has proved a complicated task. It is one whose outcome ultimately depends upon efforts to disaggregate and measure the influences of different factors involved. To date, attempts at the systematic measurement of certain key factors associated with mortality decline have lagged considerably behind acceptance of the importance of their measurement. An important omission has been a measure of the timing and dimensions of sanitary reform programmes which, via infrastructure development and environmental controls, had the potential to decrease the rate at which infectious diseases were transmitted. This article examines the trends which emerge from a quantification of local government expenditures on sanitary infrastructure and from attention to its phasing over time. We are concerned with two main issues: to what extent do public health expenditure data describe the public health effort, and how do trends in public health expenditure relate to the decline of mortality? Our subject is local authority sanitary reform as a factor in mortality decline and our focus is on the impact of the timing of public health expenditure rather than the reasons for that timing. We do not examine inter-relationships between sanitary reform and other factors contributing to mortality decline such as income levels and density factors. A call for a more comprehensive study of the sanitary undertakings of local government has been common amongst historians of nineteenth-century mortality decline. It has been acknowledged on both sides of the “nutrition versus sanitation” debate that a probable causal relationship exists between sanitary reforms and declining mortality levels. What has been lacking is a study of sufficient scale and detail to enable comprehensive evaluation.
BELL F. & MILLWARD R. (1999), ‘Infant mortality in Victorian Britain: an Economic and Social Analysis’, Working Papers in Economic and Social History, n°41, 46p.
The objective of this paper has been to draw out the central role played by mothers in the pattern of infant mortality in the Victorian period. The mother was a medium in the sense that her health crucially affected the three issues which determined the infant’s life chances: the condition of the foetus, the quality of the immune system, the quality and quantity of breast feeding. Because the latter cannot be readily measured, we have proxied their variations across regions and over time by a measure of female mortality. The research reported here reveals the range and quantifiable impact of mothers’ health alongside the many other factors affecting infant mortality.
The differences in infant mortality across the sample of towns did narrow in the 1870-1914 period but they remained a dominant characteristic even at the very end in the early 1900s.. The results from our research suggest that, looking at the sample as a cross section, infant mortality was lower the smaller were house occupancy rates and population densities and the bigger was the purchasing power over food. Mothers’ health had a powerful influence and this was itself strongly affected by real income levels as well as , in a small way, by environmental factors. Lower fertility levels had beneficial direct effects on infant mortality and sizeable indirect ones through mothers’ health. These relationships hold for all comparisons across towns . Over and above that, high levels of female employment were associated with high infant mortality, and reinforcing that, poor mothers’ health, The aspiring middle class in towns like Kingston-on- Thames, Tottenham and Oxford exhibited quite separate education and cultural influences on female mortality and fertility. In contrast the male mining culture as well as towns like catholic Liverpool had levels of fertility well above the average.
The conclusion about the pervasive average long term decline of infant mortality from the 1870s to the early 1900s is clear. There were some factors like rising population densities working against the decline in mortality. Opposed to that were a number of factors, the most powerful of which was the improvement in the health of females in the child bearing age range. This itself was most strongly affected by rising real incomes in terms of food which allowed better nutrition and by falling fertility rates. These factors are enough to explain much of the pattern of decline in infant mortality. No new factors are need be invoked, that is, to account for the very large fall in infant mortality in the textile areas and in suburbia nor the very small change in the mining areas. Real incomes rose strongly and fertility fell dramatically in the textile areas and in suburbia but by only small amounts in mining. In the middle range were the rural areas - typical, it turns out, of the average decline in infant mortality in the country as a whole and triggered by an average improvement in real incomes and fertility levels. Rising child survival rates were one of the factors which was pushing down the fertility levels but which came first cannot be decided by the present model though the results reported here provide some clues for further research on this process.
BIDEAU B., DESJARDINS B. & PÉREZ BRIGNOLI H. (1998), Infant and Child Mortality in the Past, Oxford University Press.
This volume examines the trends of early-age mortality across time and space and the methodological and theoretical problems inherent in such studies. The approach is interdisciplinary, with contributions from demography, biology, medicine, and economic and social history. The geographical range encompasses Europe, North America, Japan, and India
BIDEAU B., SCHOFIELD R. & REHER D.S. (1991), The Decline of mortality in Europe, Oxford University Press.
This book examines the remarkable decline of mortality in Europe which began in the 19th
century and continued in an uninterrupted fashion, into the early 20th century. During this period there was almost a simultaneous decline in both fertility and mortality in Europe which has long since fascinated historians and demographers. Though transition of fertility is now understood, the same cannot be said for mortality, despite its importance. The transition of mortality between 1870 and 1920 had profound effects for European and American societies. This volume brings to light the different positions held by scholars on such strategic issues as nutrition, income levels and living standards, public health, social organization, and scientific advances. This study will be of particular interest to demographers, social and economic historians, epidemiologists, and postgraduate and advanced undergraduate students of these subjects.
CORSINI C.A. & VIAZZO P.P. (1997), The decline of infant and child mortality, UNICEF, Martinus Nijhoff Publishers, 258p.
Of the many changes that have taken place in Western society during the past two centuries, few have been more significant than the steep fall in infant and child mortality. However, the timing and causes of the decline are still poorly understood. While some scholars attribute it to general improvements in living standards, others emphasize the role of social intervention and public health reforms. Written by specialists from several disciplinary fields, the twelve essays in this book break entirely new ground by providing a long-term perspective that challenges some deep-rooted ideas about the European experience of mortality decline and may help explain the forces and causal relationships behind the still tragic incidence of preventable infant and child deaths in many parts of the world today. This book will become a standard work for students and researchers in demography, social and economic history, population geography, and the history of medicine, and it will be of interest to anyone concerned with current debates on the policies to be adopted to curb infant and child mortality in both developed and developing countries.
DEVEREUX S. (2000), Famine in the Twentieth century, IDS Working Paper, n°105, 40p.
More than 70 million people died in famines in the twentieth century. Stephen Devereux has compiled data from over 30 major famines and has assessed the success of some parts of the world, notably China, the Soviet Union, India and Bangladesh in apparently eradicating mass mortality food crises. He contrasts this with the experience of sub-Saharan Africa, where famines triggered by the relationship between drought and civil war have become endemic since the late 1960s. Devereux argues that if famine is to be eradicated during the twenty-first century, it requires not only technical capacity in terms of food production and distribution, but also substantially more political will, at national and international levels, than has been seen to date.
FETTER B. (2001), ‘Human Initiative in Mortality Reduction Toward a Redefinition of Historical Mortality’, Annales de démographie historique, n°1.
No abstract available.
FOGEL R.W. (2004), The Escape from Hunger and Premature Death, 1700–2100, Europe, America, and the Third World, Cambridge Studies in Population, Economy and Society in Past Time, no. 38.
Nobel laureate Robert Fogel’s compelling new study examines health, nutrition and technology over the last three centuries and beyond. Throughout most of human history, chronic malnutrition has been the norm. During the past three centuries, however, a synergy between improvements in productive technology and in human physiology has enabled humans to more than double their average longevity and to increase their average body size by over 50 per cent. Larger, healthier humans have contributed to the acceleration of economic growth and technological change, resulting in reduced economic inequality, declining hours of work and a corresponding increase in leisure time. Increased longevity has also brought increased demand for health care. Professor Fogel argues that health care should be viewed as the growth industry of the twenty-first century and systems of financing it should be reformed. His book will be essential reading for all those interested in economics, demography, history and health care policy.
HARRIS B. (2004), ‘Public Health, Nutrition, and the Decline of Mortality: The McKeown Thesis Revisited’, Social History of Medicine, 17(3), pp. 379-407.
The medical writer, Thomas McKeown, can justifiably claim to have been one of the most influential figures in the development of the social history of medicine during the third quarter of the twentieth century. Between 1955 and his death in 1988, he published a stream of articles and books in which he outlined his ideas about the reasons for the decline of mortality and the “modern rise of population” in Britain and other countries from the early eighteenth century onwards. Although McKeown’s main aim was to deflate the claims made by the proponents of therapeutic medicine, his publications have sparked a long and protracted debate about the respective roles of improvements in sanitation and nutrition in the process of mortality decline, with particular emphasis in recent years on the impact of sanitary reform in the second half of the nineteenth century. This article attempts to place the debate over the “McKeown thesis” in a more long-term context, by looking at the determinants of mortality change in England and Wales throughout the whole of the period between c. 1750 and 1914, and pays particular attention to the role of nutrition. It offers a qualified defence of the McKeown hypothesis, and argues that nutrition needs to be regarded as one of a battery of factors, often interacting, which played a key role in Britain’s mortality transition.
LEE K.-S. (2007), ‘Infant Mortality Decline in the Late 19th Century and Early 20th Century: Role of Market Milk’, Perspectives in Biology and Medicine, Vol 50(4).
Starting in the late and early 20th centuries, an unprecedented decline in infant mortality was observed in the U. S. and Western Europe. Economic growth, improved nutrition, new sanitary measures, and an advance in knowledge for the infant care were implicated to this decline in infant mortality. Only a few investigated how these individual factors affected disease-specific components of infant mortality over time. The thematic investigative review on historical data suggests that cleaning the market milk supply was the single most important contributor to this decline in both diarrheal and overall infant mortality and took a far more important role than family income, other sanitary measures, or a medical intervention.
LE LUYER B. & SAUTEREAU M. (1992), ‘Du lait qui tue au lait qui sauve : histoire d’une révolution médicale et culturelle, 1870-1930’, Cahiers d’Histoire, vol. 37, no3-4, pp. 279-308.
Milk is always the first source food in the life of newborn infants. However, with the industrial revolution, many women worked, and breast-feeding was substituted with bottle-feeding. Despite the work by Pasteur which contributed to producing sterilised milk, bottle-feeding was carried out under appalling hygiene conditions and infant mortality was high until laws and milk production and distribution regulations were imposed between 1870 and 1930.
LIVI-BACCI M. (1983), “The Nutrition-Mortality Link in past Times: A Comment”, Journal of Interdisciplinary History, Vol. 14(2), n° special “Hunger and History: The Impact of Changing Food Production and Consumption Patterns on Society”, pp. 293- 298.
No abstract available.
MCKEOWN T. (1976), The Modern Rise of Population, E. Arnold, 168p.
No abstract available.
ROLLET-ECHALIER C. (1978), ‘Allaitement, mise en nourrice et mortalité infantile en France à la fin du XIXe siècle’, Population, Volume 33, Numéro 6, pp. 1189-1203.
Through administrative sources, we know the number of babies placed with a wet nurse between 1890-1910 in France and the number that died before they were a year old. This enables to draw up a map of feeding methods in France at that time: north of the Loire the most frequently used method was animal milk, whereas in the Mediterranean regions breast feeding was more frequent. The reasons for these considerable regional differences are to be found on the one hand in the industrial locations and women’s jobs which resulted from it, and on the other the location of livestock farming areas. This had significant consequences on infant mortality, which was high before Pasteur in the bottle-feeding regions but also high in those infants weaned late.
ROLLET-ECHALIER C. (2001), ‘La santé et la protection de l’enfant vues à travers les Congrès internationaux (1880-1920)’, Annales de démographie historique.
Although each industrialised country has a unique history of infancy, it is also true that a common culture emerged from the end of the XIXth century, at the time when international congresses became interested in infancy, sometimes exclusively dedicated to this topic. The stages of this construction are analysed from a sample of conferences devoted to the protection of infants and Gouttes de Lait. The first approach, strongly marked by the French experience, can be qualified as a legal-administrative approach: it involves the protection of infants at risk. The influence of the Latin countries and particularly France prevails. The second approach is medical: it involves fighting against infant mortality through appropriate means. This approach is empirical and technical and is also marked by French and European influences. The third approach is orientated towards the link between mother and child, education and the role of women as professionals and bears the sign of change in the power struggle during the First World War. The influence of the United States and the Anglo-Saxon example of the family came to the fore..
ROLLET-ECHALIER C. (1991), La politique à l’égard de la petite enfance sous la IIIe République, Paris, INED.
No abstract available.
ROLLET-ECHALIER C., ‘The fight against infant mortality in the past: an international comparison’, in BIDEAU B., DESJARDINS B. & PÉREZ BRIGNOLI H. (1998), Infant and Child Mortality in the Past, Oxford University Press, pp. 38-60.
This article critically examines the role of medicine, government, and people in reducing infant mortality (IM) in industrialized countries and in reaching demographic transition. IM decline tends not to be a linear process. Meckel (1990) and Rollet (1990s) indicate 3-4 stages in the awareness of IM. By the mid-1860s, IM was acknowledged as a social, demographic, and political problem. The 2nd stage, around 1880-90, focused on doctors and the technology. The 3rd stage focused at the turn of the century on the role of mothers. The 4th stage, after World War I, views children in a family context and according to financial needs. Countries have different public and private sector roles to protect children. Some countries were organized around a strong central authority, while the US had a decentralized structure with less continuity. The state and private sectors emphasized social needs and lower class responses to social controls. Medical intervention styles varied between countries. The French model linked medical visits with milk distribution and education of new mothers. The US offered milk distribution centers, but without consultations. French consultation systems did not agree with the British value system. Women in the US always played a strong role in child welfare. The UN passed the Declaration of the Rights of the Child. Child welfare was first viewed as key to a nation’s well-being and then as the object of specific policies. Now the principles of milk and medicine plus tenderness and personalized care are widely accepted. All societies had a continuous, dynamic demographic process. Many unanswered questions remain.
SRETZER S. (1988), ‘The Importance of Social Intervention in Britain’s Mortality Decline c.1850-1914: a Re-interpretation of The Role of Public Health’, Social History of Medicine, 1(1):1-38.
It continues to be generally accepted that the iconoclastic research work of Professor Thomas McKeown and associates conclusively demonstrated that the medical establishment including all the efforts of the public health movement-played only a minor role in the grand historical and demographic drama of the period, the secular decline in national mortality levels. According to McKeown’s apparently authoritative analysis and interpretation of the available epidemiological statistics, the mortality decline in England and Wales can be primarily accounted for by the benevolent “invisible hand” of gradually rising living standards, particularly in the form of increases in per capita nutritional consumption. The coherence of this view is brought into question by a critical re-examination of the supporting evidence and arguments presented by McKeown et al. It is anticipated that for many of those not closely acquainted with the “McKeown thesis”, the fragility of the case may come as something of a surprise. An alternative interpretation of the same epidemiological evidence then forms the basis for a revisionist account which directs attention to the leading role played by the public health movement and its locally administered preventive health measures in combating the urban congestion created by industrialization.
WILLIAMS, N.J. AND GALLEY, C. (1995) “Urban-rural differentials in infant mortality in Victorian England”, Population Studies, vol. 49, pp. 401-20.
This paper examines the magnitude of urban-rural differentials in infant mortality in England during the nineteenth and early twentieth centuries and also compares the timing of decline for a selection of towns of varying size, and their immediate rural hinterlands. Most towns continued to experience short-term fluctuations in infant mortality until the very end of the nineteenth century; however, in some of the adjacent rural communities – where levels of infant mortality were much lower – conditions were sufficiently favourable to allow a continuous decline in infant mortality from at least the 1860s, if not before. The final part of the paper considers the causes of these patterns and their implications for explanations of infant mortality decline.
WILLIAMS, N. J. AND MOONEY, G. (1994) ‘Infant mortality in the age of great cities: London and the English provincial cities compared c.1840-1910’, Continuity and Change, 9, pp.185-212.
This study uses published vital registration data to construct annual infant mortality rates for 21 large English towns and 25 districts in London between 1840 and 1910. Using a comparative geographical approach, differentials in levels of infant mortality and short-run cyclical movements are examined. While local factors (urban growth, prevailing sanitary conditions, methods of feeding and the quality of the milk supply) all affected levels of infant mortality, the close correspondence in the timing of movements of infant mortality suggest that a more general set of factors operated throughout the entire urban system at the same time. Of these, the interaction of climate and poor sanitary conditions is given particular emphasis.
WOODS R. I., WATTERSON P. A. & WOODWARD, J.H. (1988 & 1989) ‘The causes of rapid infant mortality decline in England and Wales, 1861-1921’Part I, 1988, Population Studies 42, pp.343-68, and Part II, 1989, Population Studies, 34, pp.113-32.