Impacts of the 1918 flu on survivors’ nutritional status: a double quasi-natural experiment

Abstract

ABSTRACTA unique set of events that took place in Puerto Rico during 1918-1919 generated conditions of a “double “quasi-natural experiment. We exploit these conditions to empirically identify effects of exposure to the 1918 flu pandemic, those of the devastation left by an earthquake-tsunami that struck the island in 1918, and those associated with the joint occurrence of these events. We use geographic variation to identify the effects of the quake and timing of birth variation to identify those of the flu. In addition, we use markers of nutritional status gathered in a nationally representative sample of individuals aged 75 and older in 2002. This unique data set enables to make two distinct contributions. First, unlike most fetal-origins research that singles out early nutritional status as a determinant of adult health, we test the hypothesis that the 1918 flu had deleterious effects on the nutritional status on adult survivors who at the time of the flu were in utero or infants. Second, and unlike most research on the effects of the flu, we focus on markers of nutritional status set when the adult survivors were children or adolescents. We find that estimates of effects of the pandemic are sizeable primarily among females and among those who, in addition to the flu, were exposed to the earthquake-tsunami. We argue that these findings constitute empirical evidence supporting the conjecture that effects of the 1918 flu alone and the combined effects of the flu and the earthquake are associated not just with damage experienced during the fetal period but also postnatally.