similar income levels. ‘The worldwide decline in mortality after WWII
happened because two hundred years of progress against mortality in the now-
rich countries was rapidly brought to bear on mortality in the rest of the world’
(Cutler et al., 2006:107). Such treatments were introduced rapidly across the
developing world after 1950, often under the auspices of donor organizations.
Examples of the rapid and successful diffusion of new treatments include peni-
cillin (discovered in 1927), sulfa drugs (1932), streptomycin (shown to treat
tuberculosis in 1943) and chloroquine (shown to treat malaria in 1943). By the
1950s the medical profession had accumulated much low-hanging fruit wait-
ing to be exploited in developing countries. In India the National Malaria
Control Programme was introduced in 1953 when the annual incidence of
malaria was estimated to be 75 million with 800,000 deaths. By the late 1950s
annual incidence had dropped to 2 million, with around 150,000 deaths. In Sri
Lanka, between 1945 and 1955, mass spraying of insecticide to kill mosqui-
toes reduced the crude death rate from malaria by 50 per cent. This measure
was estimated to have saved more than 250,000 lives and opened up large areas
of farmland to cultivation (Gray, 1974:21).
East Asia passed rapidly through the second stage of the demographic tran-
sition. Between 1960 and 1992 mortality declined rapidly. Life expectancy
increased from 61.2 to 74.6 years, driven by declines in mortality among
younger age groups. Reasonably rapid growth of agricultural output improved
general nutrition (Bloom and Williamson, 1998). In China life expectancy rose
by nearly 30 years after 1950 and in Africa life expectancy rose more than 13
years from the early 1950s to the late 1980s,before declining due to AIDS/HIV.
The relationship between life expectancy and income has shifted during the
twentieth century. For countries with per capita annual incomes between $100
and $500 life expectancy was around 10–12 years higher in the 1960s than in
the 1930s. This was the low-hanging fruit effect, which was largely independ-
ent of income and accounted for around 75–90 per cent of the growth in life
expectancy for the world as a whole between the 1930s and the 1960s (Preston,
2007).
Fertility remains high in the second stage of the demographic transition.
Insufficient time has elapsed for fundamental structural change in the econ-
omy, such as urbanization or industrialization, so economic benefits and ample
labouring opportunities remain for (illiterate) children in subsistence agricul-
ture. Women can still combine household and agricultural labour with child
bearing and rearing, and children provide a form of insurance in the parents’
old age and security for the household. In India the TFR remained at around six
children per woman between the 1880s and 1950s (Dyson, 2005:21).
With high fertility and falling mortality population growth accelerates, and
in many post-war developing countries reached 3–4 per cent annually.
Mortality took longer to fall historically in the now-developed countries that
had to learn from scratch the efficacy of such public health interventions rather
than watch and learn, so they never experienced population growth much
above 1.5 per cent per annum.
Population and Economic Growth/Development 87