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Urban bias in Latin American causes of death patterns

  • Garcia, Jenny
Publication Date
Jun 19, 2020


In 1977, Michael Lipton introduced the Urban Bias Thesis as a framework for understanding how most macro- and microeconomic policy initiatives have historically benefited the overdevelopment of urban areas and the underdevelopment of rural areas, as a result of the historical urban bias in resource reallocation. In Latin America, urbanization and mortality decline have historically been positively related: the health transition in the region has been initiated in the main cities and has tended to proceed more rapidly in countries with higher levels of urbanization. Given this context, this research looks for evidence on two phenomena: the persistence of an urban advantage in mortality; and traces of an “urban bias” in the causes of death patterns in the region. Using a sample of Latin American countries over the period 2000-2010, I apply decomposition methods on life expectancy at birth to analyze the disparities in mortality patterns and causes of death when urban and rural areas are considered separately. Urban is defined as a continuum category instead of a dichotomous concept. Hence, three types of spatial groups are recognizable in each country: main and large cities (more than 500,000 inhabitants); medium-sized and small cities (20,000 to 499,000 inhabitants); and towns and purely rural areas combined (less than 20,000 inhabitants). The countries under analysis are Brazil, Chile, Colombia, Ecuador, Mexico, Peru and Venezuela. Because comparability across time and countries is needed to ensure a high standard of data quality, two major issues are taken into consideration: coverage errors identified as underreporting levels; and quality errors in reported age, sex, residence and causes of death. The results indicate that the urban advantage is persistent and that rural-urban mortality differentials have consistently favored cities. Hardly any improvement in declining mortality exists in older adult ages outside the main and large cities. This urban advantage in mortality comes as an outcome of lower rates for causes of death that are amenable to primary interventions, meaning they are made amenable by the existence of basic public infrastructures as well as by the provision of basic goods and services. Countries and subpopulations are benefiting differently from progress: in the most urbanized countries, spatial-group mortality patterns are converging; while differentials remain in the least urbanized countries.

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