|The Nutrition and Health Transition of Democratic Costa Rica (INFDC, 1995, 228 p.)|
|4. Evolution of an epidemiological profile|
During the first four decades of this century, the health situation was characterized by high mortality rates among infants and the population as a whole and by an erratic behavior of these indicators. The overall mortality rate declined only from 24.0 to 17.1/1,000, an average annual rate of reduction of 0.7%. Mortality rates fluctuated widely, particularly during the first three decades, reaching as high as 28.7/1,000 in 1920 (Sz, 1990). It is noticeable thee the increase in mortality that took place between 1900 and 1920 (4.7/1,000) is higher than the total mortality rate recorded in the country during 1980 (4.1/1,000).
Infant mortality followed a similar pattern, characterized by an increase during the initial decades that reached 248 infant deaths per 1,000 live births in 1920. The reduction in infant mortality during this stage was only 0.8% per year. Traditionally, malnutrition and unsanitary environments have been associated with high mortality rates among children under five years old. During this stage, under-five child mortality was very high, and instead of declining, it increased from 47% to 52%. By contrast, the mortality among people aged 50 years or older was very low, because only 23% of the population reached this age. Nevertheless, life expectancy at birch increased from 35.1 years in 1910 to 46.9 years in 1940.
Mortality caused by infectious and parasitic diseases represented the main health problem, and these conditions accounted for 65% of all deaths in 1920. The behavior of this parameter was very erratic, and its rate fluctuated between 186.1 and 81.3/10,000, with an annual rate of reduction of only 0.6% between 1910 and 1940. Intestinal parasites, malaria, tuberculosis, and respiratory infections accounted for a large proportion of deaths during this period.
The national economy, which was very vulnerable at this stage, experienced a series of crises thee led to the fall of the liberal economic system and the economic impoverishment of the country, which affected the low-income groups more severely. The emerging middle class was unable to fulfill its expectations of improvements, many small-land workers lost their land, and the people who received a steady income either lost their jobs or experienced a net reduction in their salaries (Rosero, 1984). The educational level was very low, with an illiteracy rate of 54.8% at the beginning of this period that declined to 26.7% by the end.
Most health-related welfare activities were undertaken by the private sector and charity organizations. The government levied a "welfare tax" thee was used to finance existing hospitals that were run by organizations formed by community leaders; these organizations in face acted with a great deal of autonomy. In addition, several counties in the country had health centers thee provided poor people with medical care and preventive services for the control of epidemics.
Preventive health policy was oriented coward legislation and the creation of organizations for the resolution of specific problems. This process culminated in 1927 with the creation of the Ministry of Public Health and Social Protection.