title: Decolonization and life expectancy in the Caribbean.
abstract: 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.
authors: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands; Institute for Public Health (VIC), Ministry of Public Health, Environment and Nature, Willemstad, Curaçao. Electronic address: S.verstraeten@vic.cw.
authors: Soraya P A
authors: SP
authors: Verstraeten
authors: 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.
authors: Hans A M
authors: HA
authors: van Oers
authors: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
authors: Johan P
authors: JP
authors: Mackenbach
mesh_terms: D017691:Caribbean Region; D059066:Gross Domestic Product / Q000639:trends*; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D012959:Socioeconomic Factors
keywords: Caribbean; Decolonization; Independence; Life expectancy; Political transition; Politics; State formation