Short and Medium-Run Health and Literacy Impacts of the 1918 Spanish Flu Pandemic in Brazil

Abstract

We study the lasting repercussions of the 1918 influenza (‘Spanish Flu’) pandemic on health
measures and literacy rates in Sao Paulo, Brazil, the most populous city in South America
today, but significantly poorer a century ago. Leveraging temporal and spatial variation in
district-level estimates of influenza-related deaths for the 1917-1920 time-period combined
with a unique database on demographic and literacy outcomes as well as a detailed set of
socio-economic, infrastructure and regional determinants newly constructed from historical
data, we find that the pandemic had significant impacts. In particular, infant mortality and
stillbirths rose, sex ratios at birth fell, and there was a marked improvement in male literacy
rates for those 15 years and above in 1920. Further analyses reveal that these impacts are
most pronounced in districts with older populations, less literate districts, and in districts
where access to doctors was relatively limited. We find evidence that the male literacy effects
persist in 1940. These results highlight that ramifications of the 1918 Spanish Flu pandemic
were experienced for at least two decades after the event in a context where institutions were
relatively weak and resources for mitigation were limited.

Note:
Funding Information: This project was made possible by a Provost Research Grant and the Brazil Initiative at Brandeis University.

Declaration of Interests None.

Keywords: 1918 Influenza Pandemic, Infant Mortality, Stillbirths, Literacy Rates, Sao Paulo, Brazil

JEL Classification: N36, O12, I15, J10