infant mortality rate (IMR) to 415 infant deaths per 1000 births, and life
expectancy fell to 9 years (Dyson, 2005). Epidemic disease also has devastat-
ing effects. In the Indian state of Bombay in 1918, influenza reduced life
expectancy to about 6 years. The virus killed millions across the world, in both
developed and developing countries. Bubonic plague, introduced into Bombay
by ship in 1896, caused 12 million deaths in the years to 1921. Throughout the
nineteenth century British efforts at famine relief in India were poorly organ-
ized. Some administrators believed that free markets could deal with the prob-
lem; that food scarcity would raise prices, giving farmers and traders an
incentive to transport supplies to famine threatened areas. Some administrators
were concerned that spending on famine relief would make the problem worse
in the long run by stimulating population growth. The Famine Commission
Report of 1880 and the Famine Reports of 1898 and 1901 established admin-
istrative procedures and systems of relief which played a role in reducing the
effects of famine, especially after 1901 (Dyson, 2005).
During this first stage the high rates of fertility and mortality more or less
cancel out such that population growth tends to be slow. India during the nine-
teenth century was typical. Population growth averaged around 0.5 per cent per
annum; this trend was dominated by those sharp year-to-year fluctuations.
Stage two: mortality declines, fertility remains high and population
growth accelerates
In the second stage mortality falls rapidly. Mortality can be significantly
reduced in the poorest developing countries through simple medical interven-
tions and behavioural changes. Cheap and easy health-care treatments are
introduced and reduce death from disease and those transmitted via the faecal-
oral route through contaminated water causing diarrhoea and dehydration. For
example, treatment for diarrhoea is generally easy, through oral rehydration
therapy (a mixture of sugar, salt and water), and prevention is simple through
regular hand washing with soap and boiling drinking water. For measles,
which in the poorest countries is a substantial cause of morbidity and mortal-
ity, a single dose of a cheap vaccine is enough to give lifetime protection. Such
treatments are affordable even for the poorest countries and await only the
understanding, will and minimal finance to introduce them. In the poorest
developing countries three-quarters of rural households cook with
unprocessed solid fuels such as dried animal dung, crop residues, wood, char-
coal and coal. These produce hazardous emissions when burnt in inefficient
traditional stoves in poorly ventilated households and so are often most
dangerous for women and children at home. Household air pollution is
strongly linked with acute respiratory infection in children, and chronic
obstructive pulmonary disease in adults. The problem can be tackled cheaply
through education and the provision of improved stoves.
In the decades after the 1950s developing countries reduced levels of
mortality more quickly than the developed countries had done in the past at
86 Sources of Growth in the Modern World Economy since 1950