Antonio D. Cámara

The health transition and biological living standards: adult height and mortality in 20th-century Spain.

This paper seeks new insights concerning the health transition in 20th century Spain by analyzing both traditional (mortality-based) and alternative (anthropometric-based) health indicators. Data were drawn from national censuses, vital and cause-of-death statistics and seven National Health Surveys dating from 1987 to 2006 (almost 100,000 subjects aged 20-79 were used to compute cohort height averages). A multivariate regression analysis was performed on infant mortality and economic/historical dummy variables. Our results agree with the general timing of the health transition process in Spain as has been described to date insofar as we document that there was a rapid improvement of sanitary and health care related factors during the second half of the 20th century reflected by a steady decline in infant mortality and increase in adult height. However, the association between adult height and infant mortality turned out to be not linear. In addition, remarkable gender differences emerged: mean height increased continuously for male cohorts born after 1940 but meaningful improvements in height among female cohorts was not attained until the late 1950s.

A biosocial approach to living conditions: inter-generational changes of stature dimorphism in 20th-century Spain.

Abstarct Background: Applying sexual stature dimorphism (SSD) to history and the social sciences faces the difficulty of disentangling nature from nurture in addition to the limitations of sources (e.g. small, fragmented or heterogeneous samples). Aim: To investigate the relationship between inter-generational changes and social differences in SSD and the evolution of living conditions in 20th-century Spain. Subjects and methods: Self-reported height and socio-demographic information from individuals born 1910–1979 (n = 99 023) were drawn from health interview surveys. Weighed least squares regression was used to construct continuous time-cohort series of SSD for the entire population and for specific socioeconomic groups represented by levels of educational attainment. Results: SSD remained below modern values among cohorts that were exposed to structural deprivation at pre-adult ages. Socioeconomic status mediated the correction of these deviations among subsequent cohorts. Lower classes (less educated segments of the population) systematically deviated to a greater extent from normal modern SSD values and they reached these values later in time. Conclusions: In Spain, variations in SSD have been found that are associated with both socioeconomic changes at a nationwide level and SES differentials at the individual level, thus continuous series of this indicator offer new opportunities in the study of living conditions of current and past generations.

Ciclos largos de nivel de vida biológico en España (1750–1950): propuesta metodológica y evidencias locales

This work proposes an applied methodology based on the logistic regression to establish the sign of long-term trends in height from male anthropometric data collected since the Ancient Regime when mandatory conscription system was implemented in Spain. Data refer to male cohorts born from mid 18th century to mid 20th century. Broad cohort aggregations and control on the minimum required height as well as on age and municipality serve to implement the logistic regression model. Results display a downward trend in stature for cohorts born throughout the 19th century taking those born prior to 1800 as the reference. These results are statistically significant for the cohort group 1850-1899 as well as for those born after 1900 who display a clear recovery. Given that the 19th-century local series constructed in Spain up to now show similar trends, we think that these outcomes may serve as a first valid approach to the trends followed by the nutritional status prior to the socioeconomic modernization process experienced by Spain. KEY Classification-JEL: I39, I19, N50, P25

Posición en el hogar y género. Desigualdades en la calidad de vida relacionada con la salud entre la población adulta en España

This paper applies a gender perspective to explore the relationship between the position of individuals within the household and the health-related quality of life (CVRS) among the population aged 30 to 64 living in Spain (N=13.258). Microdata from the Spanish sample of the European Health Survey of 2009 are utilized for this purpose. Multivariate linear regression models for males and females are run which include the following controllers: age, labor status, educational level, social capital, nationality and variables approaching individuals’ objective health. Results show that, among females, the position within the household is more influential on CVRS than some other individual characteristics. This is not the case among males. One-parent family is the household position that penalize CVRS the most which stands especially for females. Among males, living (or not) in couple is the most influential factor on CVRS. Gender-related determinants are discussed.

Nutrición y desigualdad en el largo plazo: ¿qué enseña la historia antropométrica sobre España?

This article underlines the relevance of anthropometric history among the disciplines concerned with health and nutrition. The examination of changes on the nutritional status and inequality in Spain focused the 4th Anthropometric History Workshop held at the beginning of 2018 where 18 original contributions were presented and discussed. We first show the ability of human stature to approach the impact of socioeconomic processes and environmental changes on the nutritional status over the last centuries. Then it is proceeded to present the main contents and advances achieved in the workshop. The papers coped with diverse dimensions of inequality regarding nutritional health and its determinants since the end of the 18th century until 2015. Aside of height and weight at different ages, principally adult ones, others anthropometric indicators were analyzed such as sexual dimorphism and low weight at birth. The results illustrate the large prevalence of malnutrition and social inequality in past Spain. These problems persisted over a good part of the 20th century (i.e. stunting) and, they acquired a different nature since the 1980s as the increasing prevalence of overweight and obesity reveals. It is concluded that the determinants of nutritional status and health-related inequalities request multidimensional approaches and the dialogue between social sciences and biomedical sciences. Knowing about their dimensions in the past and their evolution over time provides a valuable basis in order to understand current problems in these areas and to address future public policies more adequately on childhood and adolescence.

La evolución de la desigualdad del estado nutricional al sur de la Comunidad Valenciana: un análisis antropométrico de Elche y Orihuela entre 1840 y 1984

INTRODUCTION many studies have used anthropometric data to approach the evolution of the net nutritional status but those focused on its socioeconomic differentials over time are still a few in Spain. OBJECTIVE to analyze the evolution of nutritional inequalities in the long run by using a sample of male statures from the Spanish towns of Elche and Orihuela. METHODS we use anthropometric and sociodemographic data entailed to conscripts aged 19-21 who were born between 1840 and 1964 and were measured between 1860 and 1984. Anthropometric inequalities are approached by analyzing height percentiles series, variation coefficient series as well as height series by socio-educational status: literate, illiterate and students. RESULTS there is a solid association between low height averages (poor nutritional status) and more heterogeneous height distribution (higher inequality). The highest values of the variation coefficient as well as the larger differences by socio-educational status are found during the central decades of the 19th century and during the context of the Spanish Civil War and the first postwar decade. CONCLUSION nutritional inequalities as reflected by heights decreased from very high levels prior to the nutrition and epidemiological transitions moderate levels during such transitions. Nevertheless, an increase in nutritional inequality is found among the cohorts born during the decade of the 1940s which were fully or partially raised during the advanced stage of the nutrition transition.Introduccion: existen numerosos estudios que han utilizado datos antropometricos para aproximarse a la evolucion del estado nutricional neto, pero los centrados en la evolucion de las diferencias socioeconomicas en este plano del bienestar son aun escasos para Espana. Objetivo: analizar la evolucion de la desigualdad del estado nutricional en el largo plazo a traves de una muestra de estaturas masculinas en las ciudades de Elche y Orihuela. Metodos: se utilizan datos antropometricos y sociodemograficos del reclutamiento militar por quintas: varones de entre 19 y 21 anos nacidos entre 1840 y 1964 que fueron examinados entre 1860 y 1984. Se analiza la desigualdad antropometrica mediante el estudio de percentiles, coeficiente de variacion y series de estatura media por segmentos socioeducativos: alfabetizados, analfabetos y estudiantes. Resultados: se observa una asociacion entre promedios bajos de estatura (estado nutricional pobre) y una distribucion mas heterogenea del parametro antropometrico (mayor desigualdad). Los valores mas altos del coeficiente de variacion, asi como las diferencias mas notables en terminos socioeducativos, se registran durante las decadas centrales del siglo xix y durante la coyuntura de la Guerra Civil y la primera posguerra. Conclusion: la desigualdad en el estado nutricional se redujo desde niveles muy altos en la fase previa a la transicion nutricional y epidemiologica a niveles moderados durante dichas transiciones. No obstante, se registra un nuevo aumento de la desigualdad entre las generaciones nacidas a partir de la decada de 1940 cuyo ciclo de vida se desarrollo total o parcialmente en la fase avanzada de la transicion nutricional.

Sobre la asociación entre el dimorfismo sexual en estatura y el estado nutricional de hombres y mujeres en el largo plazo

INTRODUCTION height variations across cohorts are a proxy of the evolution of living conditions and, specifically, of the nutritional status of a given population. However, the interpretation of the changes in stature sexual dimorphism are controversial. OBJECTIVE to test the association between nutritional status and the changes in height differentials between men and women (sexual dimorphism) in the long run (19th and 20th centuries). METHODS three data sources containing measured adult heights are used, namely: - Data from previous works. - Data from health examination surveys in OECD countries. - Data from the NCD RisC Factor Collaboration project. Two indicators are analyzed: absolute sexual dimorphism (mens height minus womens height) and the ratio of sexual dimorphism (mens height divided by womens height). RESULTS a secular trend of sexual dimorphism is evidenced over the second half of the 20th century coinciding with the substantial improvement of environmental factors that determine the net nutritional status. Among cohorts born at the end of the 20th century in non-marginal environments, the average sexual dimorphism was found to be 13.69 cm -absolute- and 1.084 -ratio-. In comparison with these modern figures of sexual dimorphism, those found among cohorts born during the 19th century are abnormally low, especially during periods of worsening of living conditions. CONCLUSIONS if properly addressed, sexual dimorphism has the ability to report on the degree of environmental stress and its impact on the nutritional status and its differentials across specific groups of the population both cross-sectionally and over time.

Parámetros antropométricos de los reclutas españoles antes de la transición nutricional. Análisis de las desigualdades territoriales (1858-1913)

Objetivo: analizar la geografía del estado nutricional en España y su evolución entre mediados del siglo xixy comienzos del siglo xx, etapa previa a la transición nutricional con alta prevalencia de malnutrición.Métodos: se utilizan datos antropométricos agregados (promedios provinciales de estatura) del reclutamiento militar en 1858 y 1913, así como promedios provinciales de estatura y peso procedentes de una revisión realizada entre 119.571 soldados en 1903-1906. Con estos datos se elaboran cartografía y estadísticos descriptivos.Resultados: los parámetros antropométricos de los españoles se situaban entre los valores de complexión más bajos de Europa antes de la transición nutricional. Entre 1858 y 1913, la altura media creció solo 1,43 cm. En ese periodo hubo cambios significativos en la geografía antropométrica marcados por la configuración de una polaridad nutricional a las puertas de la I Guerra Mundial: las provincias del centro y del sur de país exhiben mayor incidencia de la malnutrición crónica que las provincias del arco Noreste, que disfrutan de ventaja relativa en términos nutricionales.Conclusión:las desigualdades territoriales que configuraron una geografía polarizada del estado nutricional en España pueden asociarse en parte a los cambios ambientales del periodo, caracterizados por el inicio de la modernización y la industrialización y, asimismo, por la privación derivada de las crisis agrarias, las enfermedades y el relativo atraso tecnológico. Se destaca la relevancia de la historia antropométrica para el estudio de los niveles de vida en poblaciones del pasado y del proceso de transición nutricional.