The famine described in the song was a consequence of which of the following?

Famine is a catastrophic event, and it has long been known to be associated with increased mortality. Some investigators claim that, in addition to causing an immediate rise in mortality, famine may also have a “long-term” or “sustained” mortality consequence. In a study of the 1974–1975 Bangladesh famine, Razzaque, Alam, Wai, and Foster (1990) showed that the famine-born cohorts continued to have a higher than usual mortality in the second year of life, one year after the famine was over, then followed by a lower than usual mortality between the ages 2 and 5. Kannisto, Christensen, and Vaupel (1997), in their study of the 1866–1869 Finnish famine, reported that the famine cohort had an higher than usual mortality up to age 17 but no cohort difference afterwards.

In both cases, the famine-born cohorts continued to show a higher mortality than the non-famine cohorts after the famine was over; then the cohort difference in mortality either disappeared (in the Finnish case) or even got reversed (in the Bangladeshi case). Such a pattern, known to demographers as “mortality crossover” (Nam, 1995), was considered as evidence for both “debilitation effect” – a lingering negative impact of poor nutrition and harsh environment on individual health, and “selection effect” – a result of selective frailty processes on cohort-level mortality difference. Debilitation and selection effects may occur in non-famine situations as well. For example, Caselli and Capocaccia (1989) reported a mortality pattern in Italy that was similar to the Bangladeshi case: cohorts that experienced unfavorable conditions early in life tended to show increased cohort mortality up to a certain age, followed by reduced cohort mortality afterwards. The main difference between the Bangladeshi and Italian studies was the timing of the turning point – the crossover point in Bangladesh occurred at age two, while in Italy it occurred at age 45.

Treating mortality crossover as suggestive evidence for debilitation and selection effects represents an important step toward a better understanding of long-term health consequences of famine. Doing so, however, raises several issues that need further discussion. First of all, the above reasoning implicitly assumes that debilitation and selection effects always work against each other – that debilitation increases mortality of the famine cohort while selection decreases it – in determining the observed cohort mortality trend, but not all researchers accept that assumption without reservation (Elo & Preston, 1992). Second, the nature and dynamics of selection effects, compared to that of debilitation effects, is much less well understood. For example, while debilitation effect has been suggested to be strong at the beginning of the post-famine era and then gets weaker over time, there has been little discussion regarding whether selection effect follows similar or different trends. Without such knowledge, the claim that mortality crossover indicates changes in relative strength of debilitation and selection effects in the post-famine period becomes much less convincing. This leads to the next point. If, for some reasons, no mortality crossover is observed after a famine, what can we say about debilitation and selection?

In this research, I examined long-term mortality consequences of the 1959–1961 Great Leap Forward Famine in China. I first reviewed conceptual and methodological issues in identifying debilitation and selection effects. Then I proposed a statistical approach to isolate selection effect, borrowing strength from the recent developments in multilevel multiprocess latent variable modeling methodology (Lillard, 1993, Panis and Lillard, 1995, Steele et al., 2005). Using data from a large representative national sample survey conducted in 1988 in China, I (1) identified mortality crossover between the famine and the non-famine cohort; (2) demonstrated that famine may “reduce” mortality level of the famine cohort in the post-famine period by eliminating its frail members first; and (3) showed that both debilitation and selection effects declined with time, and debilitation effect declined faster than selection effect.

Cited by (37)

• Is it just a cure? Re-evaluating the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood

  2022, Social Science and Medicine

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  Very limited studies focused on the early-life adversities on infectious diseases. Taking the Great Chinese famine as a natural experiment, this study re-evaluated the long-term effect of prenatal famine exposure on infectious diseases by using nationally representative data.

  Using difference-in-difference (DID) models, we analyzed 215,216 adults who participated in the Second National Sample Survey on Disability in 2006 across 734 counties of China to detect the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood. Infectious diseases were ascertained by using the combination of self-reports or family members’ reports and on-site medical diagnosis by experienced specialists, and the severity of famine was measured by the cohort size shrinkage index (CSSI) at the county level.

  All DID estimates of the effects of famine on the probability of infectious diseases were insignificant, with a coefficient of 0.0007 (−0.0024, 0.0026) for all participants and coefficients of 0.0001 (−0.0041, 0.0043) and −0.0002 (−0.0036, 0.0033) for males and females, respectively. That is, the famine cohort dwelling in regions with a greater intensity of famine had similar levels of infectious disease risks than the cohorts with post-famine prenatal exposure experience in less affected famine regions. Furthermore, there were no significant famine and post-famine cohort differences in the DID estimates by examining the variations in subgroups with different types of infectious diseases (trachoma, poliomyelitis, tuberculosis, maternal infections and other infectious diseases).

  No significant impact of prenatal exposure to the Chinese famine was observed on the risk of infectious diseases in adulthood. Famine survivors may be “cured” by the famine and were resilient to adverse environments in their life course because selective mortality may weaken the association between adverse prenatal exposure and later health.

• Differential regulation of the DNA methylome in adults born during the Great Chinese Famine in 1959–1961

  2021, Genomics

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  Extensive epidemiological studies have established the association between exposure to early-life adversity and health status and diseases in adults. Epigenetic regulation is considered as a key mediator for this phenomenon but analysis on humans is sparse. The Great Chinese Famine lasting from 1958 to 1961 is a natural string of disasters offering a precious opportunity for elucidating the underlying epigenetic mechanism of the long-term effect of early adversity.

  Using a high-throughput array platform for DNA methylome profiling, we conducted a case-control epigenome-wide association study on early-life exposure to Chinese famine in 79 adults born during 1959–1961 and compared to 105 unexposed subjects born 1963–1964.

  The single CpG site analysis of whole epigenome revealed a predominant pattern of decreased DNA methylation levels associated with fetal exposure to famine. Four CpG sites were detected with p < 1e-06 (linked to EHMT1, CNR1, UBXN7 and ESM1 genes), 16 CpGs detected with 1e-06 < p < 1e-05 and 157 CpGs with 1e-05 < p < 1e-04, with a predominant pattern of hypomethylation. Functional annotation to genes and their enriched biological pathways mainly involved neurodevelopment, neuropsychological disorders and metabolism. Multiple sites analysis detected two top-rank differentially methylated regions harboring RNF39 on chromosome 6 and PTPRN2 on chromosome 7, both showing epigenetic association with stress-related conditions.

  Early-life exposure to famine could mediate DNA methylation regulations that persist into adulthood with broad impacts in the activities of genes and biological pathways. Results from this study provide new clues to the epigenetic embedding of early-life adversity and its impacts on adult health.

• Extreme weather and mortality: Evidence from two millennia of Chinese elites

  2021, Journal of Health Economics

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  Modern technology empowers human beings to cope with various extreme weather events. Using Chinese historical data, we examine the impact of extreme weather on long-term human mortality in an environment where individuals had no access to modern technology. By combining life-course data on 5000 Chinese elites with historical weather data over the period 1–1840 AD, we find a significant and robust negative impact of droughts in childhood on the longevity of elites. Quantitatively, encountering three years of droughts in childhood reduces an elite's life span by about two years.

• Prenatal Nutrition and Nutrition in Pregnancy: Effects on Long-Term Growth and Development

  2017, Early Nutrition and Long-Term Health: Mechanisms, Consequences, and Opportunities

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  Optimal nutritional status of the mothers is the most influential nongenetic factor for the healthy development of the fetus and well-being of mothers. Maternal malnutrition, both undernutrition and overnutrition (obesity), may lead to adverse pregnancy outcomes and can have substantial negative effects on growth and development during childhood and excess risk of developing chronic diseases during adult life. In settings of chronic malnutrition, the adverse effects can be transmitted across generations with cumulative negative and intergenerational effects. Malnourished mothers, especially adolescent girls and also multigravidas tend to give birth to low birth weight (LBW) babies (including preterm and small for gestational age babies) with excess risk of stunted growth. Such stunted children grow up to be stunted individuals entering the reproductive period with suboptimal nutritional status and repetition of these risks and adverse outcomes across the life cycle. Observational studies from animal and humans make a strong case of intergenerational effects of maternal malnutrition; however the number of intervention studies with long-term follow is small and few robust conclusions can be drawn at this stage. Further intervention studies or cohorts with key health and nutrition interventions and long-term follow-up are needed to understand the relationships of maternal nutrition and risks of adverse medium to long-term outcomes and risks of chronic disease during childhood and adulthood.

• Is natural experiment a cure? Re-examining the long-term health effects of China's 1959-1961 famine

  2016, Social Science and Medicine

  Citation Excerpt :

  Using retrospective data on family deaths from the 1988 National Survey of Fertility and Contraception, Song (2009) compared mortality between the famine and non-famine cohorts, finding no significant difference after adjusting for the cross-cohort temporal trend of mortality rate. In another study using the same data, Song (2010) found a higher mortality rate among the famine cohort up to ages 11 and 12, after which the non-famine cohort exhibited a higher mortality rate up to age 22. But given their vulnerability to recall error, and without a vital registration system for confirmation, such retrospective household survey data on family member death dates can be unreliable.

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  The fetal origins hypothesis posits that adverse prenatal exposures, particularly malnutrition, increase the risk of poor adult health. Studies using famine as a natural experiment to test the fetal origins hypothesis present conflicting findings, partly because of data limitations and modeling flaws. Capitalizing on the biomarker data and prefecture-level geographic information from the 2011 China Health and Retirement Longitudinal Study, this study estimates the effects of prenatal exposure to China's 1959–61 famine on later-life risks of cardiovascular and metabolic diseases. Our analysis addresses the problems of measurement error and intrinsic cohort differences that challenge prior studies. We use provincial and prefecture-level geographic variations in famine severity, a proxy for prenatal malnutrition, for model identification. We construct instrumental variables from geocoded newspaper archive data to adjust for measurement error in famine exposure. We find that estimates of the famine effects are highly sensitive to the choices of health indicators, measures of famine severity, and regression model specifications. Overall, we find little evidence supporting the fetal origins hypothesis. In fact, it appears that prenatal exposure to famine reduces later-life disease risks in certain cases. We interpret this finding as evidence of mortality selection among the famine survivors at work. We conclude that using famine as a natural experiment in itself does not guarantee correct statistical inference about the long-term health impacts of prenatal malnutrition when other analytical challenges remain unresolved.

• Identifying the intergenerational effects of the 1959-1961 Chinese Great Leap Forward Famine on infant mortality

  2013, Economics and Human Biology

  Citation Excerpt :

  Recent research in the fields of demography, economics, public health, and medical sciences suggests that the impact of the GLFF has extended beyond the three famine years. People born during the famine suffered from increased risk of obesity (Luo et al., 2006), schizophrenia (Song et al., 2009), metabolic syndrome (Li et al., 2011b), and hypertension (Li et al., 2011a; Huang et al., 2010b) as well as impaired fecundity (Song, 2013), reduced adult height (Chen and Zhou, 2007; Huang et al., 2010b), and poor labor market outcomes (Chen and Zhou, 2007), among others (Song, 2010; Mu and Zhang, 2011; Almond et al., 2010). A number of studies show that prenatal exposure to the GLFF may even have an “intergenerational” effect and influence the health and well-being of children of the famine cohort (Huang et al., 2010a; Kim et al., 2012; Fung and Ha, 2010).

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  Using the 1959–1961 Chinese Great Leap Forward Famine as a natural experiment, this study examines the relationship between mothers’ prenatal exposure to acute malnutrition and their children's infant mortality risk. According to the results, the effect of mothers’ prenatal famine exposure status on children's infant mortality risk depends on the level of famine severity. In regions of low famine severity, mothers’ prenatal famine exposure significantly reduces children's infant mortality, whereas in regions of high famine severity, such prenatal exposure increases children's infant mortality although the effect is not statistically significant. Such a curvilinear relationship between mothers’ prenatal malnutrition status and their children's infant mortality risk is more complicated than the linear relationship predicted by the original fetal origins hypothesis but is consistent with the more recent developmental origins of health and disease theory.

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