Short and Medium-Run Health and Literacy Impacts of the 1918 Spanish Flu Pandemic in Brazil
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 poorer 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 from over a century ago were being experienced until recently in contexts where institutions are relatively weak and resources for mitigation are limited.