The history of disease in modern South Asia has been dominated by epidemic diseases. Smallpox, cholera, and malaria, along with plague and influenza, figured prominently among the leading causes of sickness and mortality in the region for much of the period from the eighteenth to the mid-twentieth centuries. The recent decline or disappearance of several of these diseases has correspondingly resulted in a marked fall in overall levels of mortality.

Although the statistics are unreliable in detail (with perhaps a quarter or more of all deaths passing unrecorded), the broad trend is clear. From a peak mortality of nearly 50 deaths per 1,000 inhabitants in British India in the late nineteenth and early twentieth centuries, mortality rates were roughly halved by the 1950s, declining from 42.6 per 1,000 in 1901–10 and 48.6 in 1911–20, to 36.3 in 1921–30, 31.2 in 1931–40, and 27.4 in 1941–50 and 22.8 in 1951–60. In 1966–70, the figure was 15.3 per 1,000. The fall in infant mortality over the same period further confirms this trend. From an annual average of 212 deaths per 1,000 live births between 1911 and 1920, infant mortality in India fell to 176 in 1921–30, 168 in 1931–40, 148 in 1941–50, and 113 in 1966–70 (Davis 1951; Chandrasekhar 1972).

Mortality Levels

The reasons underlying this fall in mortality (and the earlier high levels of mortality) have been much debated. Kingsley Davis (1951) argued that India became “the home of great epidemics” only during the period of British rule (1757–1947), when it was “exposed to foreign contact for the first time on such a great scale.“