Population Decline Induced by Gonorrhea and Tuberculosis Transmission: Micronesia during the Japanese Occupation, 1919 – 1945

Susan L. Cassels, University of Washington

A pressing global health concern in the 21st century is the risk of rapid and widespread disease transmission and its negative demographic consequences. This historical case study, which looks at gonorrhea and tuberculosis transmission and depopulation in Micronesia during the Japanese colonial period (1919 – 1945), identifies lessons for more complex and contemporary settings involving other diseases and cultural norms. Using a simulation model that creates and tracks the reproductive histories of a cohort of women, I illustrate the potential demographic consequences of uncontrolled epidemics. Although disease is not usually thought of as having a large impact on fertility, this work shows that it should not be discounted. Especially before treatment, gonorrhea epidemics could be large and devastating, and could trigger depopulation. However, increases in mortality rates from tuberculosis were a greater determinant of population growth than were depressed fertility rates from gonorrhea infections.