Determinants of health status among the elderly population in Latin America, the Caribbean and Asia: Legacy of the Past?

During the 1930s-1960s mortality dramatically declined in many countries of the developing world primarily due to public health interventions and improved medical technology. This decline may have created a larger pool of individuals who survived poor childhood conditions. If hypotheses regarding the importance of early life exposures on adult health have merit, the health of older adults from these cohorts may be unduly influenced by early childhood conditions. We examine this conjecture by comparing cohorts born during rapid mortality decline of the 1930s-1940s due to public health interventions with those born during periods which (1) experienced a more graded and earlier mortality decline and where the reasons for mortality decline were more due to improvements in standard of living and (2) showed little or no mortality decline during the early twentieth century. We select a sample of adults 60 years and older from major studies on aging in Latin America and the Caribbean (Mexico-MHAS, SABE, Puerto Rico-PREHCO, Costa Rica-CRELES), Asia (China-CLHLS, Indonesia-IFLS) and estimate the effects of early childhood conditions (health, SES) on adult health (chronic conditions--diabetes, heart disease, obesity) controlling for adult SES, adult risk factors (smoking, exercise) using multivariate models. If our conjecture has merit (1) we expect to find stronger effects of early childhood conditions on adult health status in cohorts born during periods of rapid mortality decline primarily due to public health interventions; (2) public health policy will need to address the health needs of these cohorts as they age in the next 20-30 years.