Verstraeten Soraya P A, van Oers Hans A M, Mackenbach Johan P
Department of Public Health, Erasmus MC, Rotterdam, The Netherlands; Institute for Public Health (VIC), Ministry of Public Health, Environment and Nature, Willemstad, Curaçao.
Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, The Netherlands; National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Soc Sci Med. 2016 Dec;170:87-96. doi: 10.1016/j.socscimed.2016.08.048. Epub 2016 Sep 28.
Decolonization has brought political independence to half the Caribbean states in the last half of the 20th century, while the other states remain affiliated. Previous studies suggested a beneficial impact of affiliated status on population health, which may be mediated by more favorable economic development. We assessed how disparities in life expectancy between currently sovereign and affiliated states developed over time, whether decolonization coincided with changes in life expectancy, and whether decolonization coincided with similar changes in GDP per capita. Time-series data on life expectancy and related variables, GDP per capita and political status were collected from harmonized databases. We quantified variations in life expectancy by current political status during the 1950-2010 period. We assessed whether decolonization coincided with life expectancy trend changes by: 1. calculating the annual changes before and after independence, and 2. evaluating trend breaks in a predefined period during decolonization using joinpoint analyses. Similar analyses were undertaken for GDP per capita. Life expectancy in currently sovereign Caribbean states was already lower than in affiliated states before political independence. Overall, decolonization coincided with reductions in life expectancy growth, but not with reductions in economic growth, and changes in life expectancy growth in the decade after independence did not correspond with changes in economic performance. The widening of the life expectancy gap between currently sovereign and affiliated states accelerated in the 1990's and continues to increase. Despite considerable life expectancy gains in all Caribbean states, life expectancy in currently sovereign states increasingly lags behind that of states which remained affiliated. Our results indicate that changing economic conditions were not the main determinant of the unfavorable trends in life expectancy during and after decolonization. Circumstantial evidence points to the weakening of bureaucracies during decolonization underlying the uneven life expectancy developments of currently affiliated and sovereign states.
非殖民化在20世纪后半叶给一半的加勒比国家带来了政治独立，而其他国家仍保持附属关系。先前的研究表明附属地位对人口健康有有益影响，这可能是由更有利的经济发展介导的。我们评估了当前主权国家和附属国家之间预期寿命差距随时间的变化情况，非殖民化是否与预期寿命的变化同时发生，以及非殖民化是否与人均国内生产总值的类似变化同时发生。从统一数据库收集了预期寿命及相关变量、人均国内生产总值和政治地位的时间序列数据。我们量化了1950 - 2010年期间按当前政治地位划分的预期寿命变化。我们通过以下方式评估非殖民化是否与预期寿命趋势变化同时发生：1. 计算独立前后的年度变化；2. 使用连接点分析评估非殖民化期间预定义时间段内的趋势断点。对人均国内生产总值进行了类似分析。在政治独立之前，当前主权加勒比国家的预期寿命就已经低于附属国家。总体而言，非殖民化与预期寿命增长的下降同时发生，但与经济增长的下降不同时发生，并且独立后十年预期寿命增长的变化与经济表现的变化不相符。当前主权国家和附属国家之间预期寿命差距的扩大在20世纪90年代加速，并且仍在继续扩大。尽管所有加勒比国家的预期寿命都有显著提高，但当前主权国家的预期寿命越来越落后于仍保持附属关系的国家。我们的结果表明，经济条件的变化不是非殖民化期间及之后预期寿命不利趋势的主要决定因素。间接证据表明，非殖民化期间官僚机构的削弱是当前附属国家和主权国家预期寿命发展不均衡的基础。
