ESCAPE FROM HUNGER AND PREMATURE DEATH

ESCAPE FROM HUNGER AND PREMATURE DEATH - The Escape from...

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Unformatted text preview: The Escape from Hunger and Premature Death, 1700—2100 EUROPE, AMERICA, AND THE THIRD WORLD Robert William Fogel The University of Chicago and National Bureau of Economic Research ' ' CAMBRIDGE UNIVERSITY PRESS XX ACKNOWLEDGMENTS Walgreen Foundation, the National Bureau of Economic Research, and the University of Chicago. I am indebted to Jesse Ausubel, Bernard Harris, and Paul Waggoner, who read the penultimate draft and made many helpful suggestions. I am grateful to a number of publishers and individuals for their permission to reproduce diagrams and to republish parts of my own or jointly authored work. I would like to thank John Kim for allow- ing me to reprint Figures 5.1 and 5.2 from his dissertation and the University of Chicago Press for permission to reprint Figures 2.3 and 2.4 from Costa and Steckel 1997. Most of pages 67-—79 origi- nally appeared in R. W Fogel, “Economic and social structure for an ageing population,” Philosophical Transactions of the Royal So- ciety of London, series B, 352 (1997): 1905-17. The section “Fore- casting health care costs in China and other Third World countries” in Chapter 4 is a revised version of pages 7—10 of Robert W. Fogel, “Forecasting the demand for health care in OECD nations and China,” Contemporary Economic Policy 21 (2003): 1—10, © West- ern Economic Association International. Chapter 5 was published previously as Robert W. Fogel and Chulhee Lee, “Who gets health care?” Daedalus 131, no. 1 (2002): 107—17, © 2002 by Robert W Fogel. I would like to thank Chulhee Lee for allowing me to use material that he coauthored in this book. Part of the Appendix orig~ inally appeared as the note to Figure 3 on p. 34 of Robert William Fogel, “New sources and new techniques for the study of secular trends in nutritional status, health, mortality, and the process of aging,” Historical Methods 26 (1993): 5—43, © 1993 Robert W. Fogel; that note was written primarily by John Kim. Tables A2 and A3 appeared in the same article and were computed by John Kim. Katherine A. Chavigny and Susan E. Jones bore the brunt of the editorial work on these lectures, which included not only numerous suggestions for improvements in style but also most of the work on the citations. Katharine J. Hamerton also assisted in the editorial process. Ruma Niyogi prepared the Glossary and the Biographical Notes. The various drafts were typed by Marilyn Coopersmith, Karen Brobst, and Pat Mackins-Morrow. _. m fl~ a,,w.~.,...-.......,..,-,~,. New“ gnaw?“ .. t... wmw~ ~'~<v~—. aw >WW, Mn»w.~r-..ww~w~ an The Persistence of Misery in Europe and America before 1900 he twentieth century saw major improvements in the human condition, not only in the rich countries of the world but also in developing nations. Nothing has been more remarkable, how— ever, than the extension of life expectancy, which has increased by about 30 years since 1900 in England, France, and the United States and in equal or larger amounts in such countries as India, China, and Japan. Among the nations of the Third World, the rate of improvement has been nearly twice as fast as among the nations in the Organization for Economic Cooperation and Development (OECD) (see Table 1.1). What is responsible for this unanticipated extension of human life? That question has occupied some of the best minds of the past century in both the social sciences and the biomedical sciences, and it is also the central question of these chapters. The drive to explain the secular decline in mortality did not begin until about World War I because it was uncertain before that time whether such a decline was in progress. There was little evidence in the first four official English life tables covering the years 1831—80 of a down- ward trend in mortality. Although the signs of improvement in life 1 2 THE ESCAPE FROM HUNGER AND PREMATURE DEATH, 1700—2100 Table 1.1 Life Expectancy at Birth in Seven Nations, 1725—2100 (both sexes combined) 1725 1750 1800 1850 1900 1950 1990 2050? 2100? England 32 37 36 40 48 69 76 or UK France 26 33 42 46 67 77 U.S. 50 51 56 43 48 68 76 (87) (98) Egypt 42 60 India 27 39 59 China 41 70 Japan 61 79 Sources: For England 1725—1850: Wrigley and Schofield 1981; 1900: average of figures for 1896 and 1905 in Case et al. 1962. For France 1750: computed from Tables 13 and 14 for 1740—49 in Blayo 1975a, p. 140; for 1800, 1850, and 1900: Bourgeois—Pichar 1965, pp. 504—5 (figures for 1805—7, 1850—52, and 1900-2). For the United States 1725—1850: Fo— gel 1986, p. 511 (males only; shifted to 30" using Coale and Demeny 1966, West life tables); for 1900: Bell, Wade, and G055 1992. For India 1900: Carr-Saunders 1964 (figure is for 1931). For all countries 1950: Keyfitz and Flieger 1990; for 1990: World Bank 1990, 1992. Figures in parentheses for 2050 and 2100 are projections for these years based on the analysis of Oeppen and Vaupel (2002). expectancy became more marked when the fifth and sixth tables were constructed, covering the 18805 and 18905, few epidemiol— ogists or demographers recognized that England was in the midst of a secular decline in mortality that had begun about the second quarter of the eighteenth century and that would more than dou— ble life expectancy at birth before the end of the twentieth century. During the last decade of the nineteenth century and the early years of the twentieth century, attention was focused not on the small de- cline in aggregate mortality, but on the continuing large differen- tials between urban and rural areas, between low— and high-income districts, and among different nations} The improvements in life expectancy between 1900 and 1920 were so large, however, that it became obvious that the changes were not just a random perturbation or cyclical phenomenon. Sim- ilar declines recorded in the Scandinavian countries, France, and other European nations made it clear that the West, including Canada and the United States, had attained levels of survival far beyond previous experience and far beyond those that prevailed, elsewhere in the world.2 THE PERSISTENCE OF MISERY IN EUROPE AND AMERICA BEFORE 1900 3 The drive to explain the secular decline in mortality pushed research in three directions. Initially, much of this effort revolved around the construction of time series of birth and death rates that extended as far back in time as possible in order to determine just when the decline in mortality began. Then, as data on mortality rates became increasingly available, they were analyzed in order to determine factors that might explain the decline as well as to establish patterns or laws that would make it possible to predict the future course of mortality. Somewhat later, efforts were undertaken to determine the re— lationship between the food supply and mortality rates. Between the two world wars, the emerging science of nutrition focused on a series of diseases related to specific nutritional deficiencies. In 1922 shortages in vitamin D were shown to cause rickets. In 1933 thi— amine deficiency was identified as the cause of beriberi, and in 1937 inadequate niacin was shown to cause pellagra.3 Although the en- ergy required for basal metabolism (the energy needed to maintain vital functions when the body is completely at test) had been es— timated at the turn of the century, it was not until after World War II that estimates of caloric requirements for specific activi- ties were worked out. During the three decades following World War 11, research in nutritional sciences conjoined with new find- ings in physiology to demonstrate a previously unknown synergy between nutrition and infection and to stimulate a series of Stud- ies, still ongoing, of numerous and complex routes through which nutrition affects virtually every vital organ system.4 The effort to develop time series of mortality rates also took an enormous leap forward after World War II. Spurred by the develop— ment of high—speed computers, historical demographers in France and England developed new time series on mortality from bap— tismal and burial records that made it possible to trace changing mortality from 1541 in the case of England and from 1740 in the case of France.5 Two other critical sources of data became available during the 19705 and 19805. One was food-supply'estimates that were de— veloped in France as a by—product of the effort to reconstruct the pattern of French economic growth from the beginning of the 4 THE ESCAPE FROM HUNGER AND PREMATURE DEATH, 1700-2100 Industrial Revolution. Once constructed, the agricultural accounts could be converted into estimates of the output of calories and other nutrients available for human consumption through a tech- nique called “National Food Balance Sheets.” Such estimates are currently available for France more or less by decade from 1785 down to the present. In Great Britain the task of reconstructing the growth of the food supply was more arduous, but estimates of the supply of food are now available by half century from 1700 to 1850 and by decade for much of the twentieth century.6 The other recent set of time series pertains to physique or body builds - height, weight, and other anthropometric (bodily) mea- sures. The systematic recording of information on height was ini- tially an aspect of the development of modern armies, which be- gan to measure the height of recruits as early as the beginning of the eighteenth century in Sweden and Norway and the middle of the eighteenth century in Great Britain and its colonies such as those in North America. The measurement of weight did not become widespread in armies until the late 18605, after the development of platform scales. However, there are scattered samples of weights that go back to the beginning of the nineteenth century. During the 19605 and 1970s, recognition that data on body builds were important indicators of health and mortality led to the system- atic recovery of this information by economic and social historians seeking to explain the secular decline in mortality.7 These rich new data sources supplemented older economic time series, especially those on real wages (which began to be con— structed late in the nineteenth century) and real national income (which were constructed for OECD nations mainly between 1930 and 1960). These new sources of information about human wel- fare, together with advances in nutritional science, physiology, de— mography, and economics, form the background for these chapters. Before plunging into my own analysis and interpretation of this evidence, however, I want to summarize the evolution of thought about the causes of the secular decline in mortality. Between the late 19305 and the end of the 19605 a consensus emerged on the explanation for the secular trend. A United Nations THE PERSISTENCE OF MISERY IN EUROPE AND AMERICA BEFORE 1900 study published in 1953 attributed the trend in mortality to four categories of advances: (1) public health reforms, (2) advances in medical knowledge and practices, (3) improved personal hygiene, and (4) rising income and standards of living. A United Nations study published in 1973 added “natural factors,” such as the de- cline in the virulence of pathogens, as an additional explanatory category.8 A new phase in the effort to explain the secular decline in mor- tality was ushered in by Thomas McKeown, who, in a series of papers and books published between 1955 and the mid-19805, challenged the importance of most of the factors that previously had been advanced for the first wave of the mortality decline. He was particularly skeptical of those aspects of the consensus expla- nation that focused primarily on changes in medical technology and public health reforms. In their place he substituted improved nutrition, but he neglected the synergism between infection and nutrition and so failed to distinguish between diet and nutrients available for cellular growth. McKeown did not make his case for nutrition directly but largely through a residual argument after having rejected other principal explanations. The debate over the McKeown thesis continued through the beginning of the 19808.9 However, during the 19703 and 19803, it was overtaken by the growing debate over whether the elimination of mortality crises was the principal reason for the first wave of the mortality decline, which extended from roughly 1725 to 1825. The systematic study of mortality crises and their possible link to famines was initiated by Jean Meuvret in 1946. Such work was carried forward in France and numerous other countries on the ba— sis of local studies that made extensive use of parish records. By the early 19705, scores of such studies had been published covering the period from the seventeenth through the early nineteenth centuries in England, France, Germany, Switzerland, Spain, Italy, and the Scandinavian countries. The accumulation of local studies pro- vided the foundation for the view that mortality crises accounted for a large part of total mortality during the early modern era, and that the decline in mortality rates between the mid-eighteenth and 6 THE ESCAPE FROM HUNGER AND PREMATURE DEATH, 1700—2100 mid-nineteenth centuries was explained largely by the elimina— tion of these crises, a View that won widespread if not universal support.10 Only after the publication of death rates based on large repre- sentative samples of parishes for England and France did it become possible to assess the national impact of crisis mortality on total national mortality. Figure 1.1 displays the time series that emerged from these studies. Analyses of these series confirmed one of the im- portant conclusions derived from the local studies: Mortality was far more variable before 1750 than afterward. They also revealed that the elimination of crisis mortality, whether related to famines or not, accounted for only a small fraction of the secular decline in mortality rates. About 90 percent of the drop was due to the reduction of “normal” mortality.11 In discussing the factors that had kept past mortality rates high, the authors of the 1973 United Nations study of population noted that “although chronic food shortage has probably been more deadly to man, the effects of famines, being more spectacular, have received greater attention in the literature.”12 Similar points were made by several other scholars, but it was not until the publication of the Institut national d’études démographiques data for France and the E. A. Wrigley and R. S. Schofield data for England that the limited influence of famines on mortality became apparent. In chapter 9 of the Wrigley and Schofield volume, Ronald Lee demon- strated that although there was a statistically significant lagged re- lationship between large proportionate deviations in grain prices and similar deviations in mortality, the net effect on mortality after five years was negligible.” Similar results were reported in studies of France and the Scandinavian countries.14 The current concern with the role of chronic malnutrition in the secular decline of mortality does not represent a return to the belief that the entire secular trend in mortality can be attributed to aisingle overwhelming factor. Specialists currently working on the problem agree that a range of factors is involved, although they have different views on the relative importance of each factor. The unresolved issue, therefore, is how much each of the various factors THE PERSISTENCE OF MISERY IN EUROPE AND AMERICA BEFORE 1900 7 (a) CDR 1500 1600 1700 l 800 l900 2000 Time (b) CDR 1500 1600 I700 1800 1900 2000 Time Figure 1.1 Secular Trends in Mortality Rates in England and France. (3) England 1541—1975. (b) France 1740—1974. Note: CDR = crude death rate, which is computed as the total deaths in a given year divided by the midyear population and multiplied by 1,000. Each diagram shows the scatter of annual death rates around a 25-year moving average. On sources and procedures, see Fogel 1992, notes to Table 9.1. 8 THE ESCAPE FROM HUNGER AND PREMATURE DEATH, 1700-2100 contributed to the decline. Resolution of the issue is essentially an accounting exercise of a particularly complicated nature that in- volves measuring not only the direct effect of particular factors but also their indirect effects and their interactions with other factors. I now consider some of the new data sources and new analytical techniques that have recently been developed to help resolve this accounting problem.” The Dimensions of Misery during the Eighteenth and Nineteenth Centuries It is now clear that although the period from the middle of the eigh- teenth century to the end of the nineteenth has been hailed justly as an industrial revolution, as a great transformation in social or- ganization, and as a revolution in science, these great advances brought only modest and uneven improvements in the health, nu- tritional status, and longevity of the lower classes before 1890. Whatever contribution the technological and scientific advances of the eighteenth and nineteenth centuries may have made ultimately to this breakthrough, escape from hunger and high mortality did not become a reality for most ordinary people until the twentieth century. This point can be demonstrated by looking first at the amount of food available to the typical worker in England and France during the eighteenth and early nineteenth centuries. Because at that time food constituted between 50 and 75 percent of the expenditures of laboring families, improvement in the conditions of their lives Should have been evident in their diets. However, Table 1.2 shows that the energy value of the typical diet in France at the start of the eighteenth century was as low as that of Rwanda in 1965, the most malnourished nation for that year in the tables of the World Bank. England’s supply of food per capita exceeded that of France by several hundred calories but was still exceedingly low by current standards. Indeed, as late as 1850, the English availability of calories hardly matched the current Indian level. .. awn-w 2,... firmwmmama , T a... w ‘am‘wmwaa r , ...._/.,.w.w.iw.. v“:WWn-‘wflfi‘wnf‘vfim-KW'WWM.saw, «vrwgwaa 9 THE PERSISTENCE OF MISERY IN EUROPE AND AMERICA BEFORE 1900 Table 1.2. Secular Trends in the Daily Caloric Supply in France and Great Britain, 1700—1989 (calories per capita) ~ 7' Year France Great Britain 1700 2,095 1705 1,657 1750 2,168 1785 1,848 1800 2,237 1803-12 1,846 1845—54 2,480 1850 2,362 1909—13 2,857 1935—39 2,975 1954—55 2,783 3,231 1961 3,170 1965 3,355 3,304 1989 3,465 3,149 M— Source: Fogel, Floud, and Harris, n.d. The supply of food available to ordinary French and English families between 1700 and 1850 was not only meager in amount but also relatively poor in quality. In France between 1700 and 1850, for example, the share of calories from animal foods was less than half of the modern share, which is about one-third in rich nations. In 1750 about 20 percent of English caloric consumption was from animals. That figure rose to between 25 and 30 percent in 175 0 and 1 800, suggesting that the quality of the English diet in- creased more rapidly than that of the French during the eighteenth century. However, although the English were able to increase their diet in bulk, its quality subsequently diminished, with the share of calories from animals falling back to 20 percent in 185 0.16 One implication of these low—level diets needs to be stressed: Even prime-age males had only a meager amount of energy avail- able for work. By work I mean not only the work that gets counted in national income and product accounts (which I will call “NIPA work”), but also all activity that requires energy over and above 10 THE ESCAPE FROM HUNGER AND PREMATURE DEATH, 1700-2100 baseline maintenance. Baseline maintenance has two components. The larger component is the basal metabolic rate (or BMR), which accounts for about four—fifths of baseline maintenance. It is the amount of energy needed to keep the heart and other vital organs functioning when the body is completely at rest. It is measured when an individual is at complete rest, about 12 to 14 hours after the last meal.17 The other 20 percent of baseline maintenance is the energy needed to eat and digest food and for vital hygiene. It does not include the energy needed to prepare a meal or to clean the kitchen afterward. It is important to keep in mind that not all goods and ser- vices produced in a society are included in the NIPA. When the NIPA were first designed in the early 19305, they were intended to measure mainly goods and services traded in the market. It was, for example, recognized that many important contributions to the economy, such as the unpaid labor of housewives, would not be measured by the NIPA. However, the neglect of nonmarket activi- ties was to a large extent made necessary by the difficulty in measur- ing them given the quantitative techniques of the time. Moreover, with a quarter of the labor force unemployed in 1932, Congress was most concerned about what was happening to market employment. It was also assumed that the secular trend in the ratio of market to nonmarket work was more or less stable. This last assumption turned out to be incorrect. Over time, NIPA work has become a smaller and smaller share of total activities. Furthermore, we now have the necessary techniques to provide fairly good estimates of nonmarket activities. Hence in these chapters I will attempt to estimate the energy requirements of both market and nonmarket work. Dietary energy available for work is a residual. It is the amount of energy metabolized (chemically transformed for use by the body) during a day, less baseline maintenance. Table 1.3 shows that in rich countries today, around 1,800 to 2,600 calories of energy are available for work to an adult male aged 20—39. Note that calories for females, children, and the aged are converted into equivalent males aged 20—39, called “consuming units,” to standardize the age MVan w mwA’mewvwwmmxmv-VrmWWM-QQAM flaw—NW.» M-wmanhnzfl, mum», «v, THE PERSISTENCE OF MISERY IN EUROPE AND AMERICA BEFORE 1900 11 Table 1.3 A Comparison of Energy Available for Work Daily per Consuming Unit in France, England and Wales, and the United States, 1700—1994 (in kcal) ( 1) (2) (3) Year France England and Wales United States 1700 720 2,313“ 1705 439 1750 812 1785 600 1800 858 1840 1850 1870 1880 1944 1975 2J36 1980 1994 1,310 1,014 1,671 2,709 2,282 1,793 2,620 " Prerevolutionary Virginia. Source: Fogel, Floud, and Harris, n.d. and sex distributions of each population. This means that if females aged 15—19 consume on average 0.78 of the calories consumed on average by males aged 20—39, they are considered 0.78 of a male aged 20—39, insofar as caloric consumption is concerned, or 78 percent of a consuming unit. ‘ During the eighteenth century, France produced less than one— fifth of the current US. amount of energy available for work. Once again, eighteenth-century England was more prolific, pro— viding more than a quarter of current levels, a shortfall. of well over 1,000 calories per day. Only the United States provrded en— ergy for work equal to or greater than current levels during the eighteenth and early nineteenth centuries. When interpreting Table 1.3, it should not be assumed that work actually performed on a given day was always exactly equal to the ingested energy not used for maintenance. Work on any day can exceed or fall short of the amount allowed by the resrdual. If actual 12 THE ESCAPE FROM HUNGER AND PREMATURE DEATH, 1700—2100 work requirements fall short of that made possible by the residual, the unused energy will be stored in the body as fat. If actual work exceeds the residual, the body will provide the energy from fat stores or from lean body mass. Among impoverished populations today, work during busy seasons is often sustained by drawing on the body’s stores of energy and then replenishing these stores during slack seasons. However, when such transactions are large, they can be a dangerous way of providing the energy needed for work. Although the body has a mechanism that tends to spare the lean mass of vital organs from such energy demands, the mechanism is less than perfect and some of the energy demands are met from vital organs, thus undermining their functioning. Some investigators concerned with the link between chronic malnutrition and morbidity and mortality rates during the eigh— teenth and nineteenth centuries have focused only on the harm done to the immune system. The now famous table of nutrition— sensitive infectious diseases published in Hunger and History in 1983 stressed the way that some infectious diseases are exacerbated by the undermining of the immune system.18 Unfortunately, some scholars have misinterpreted this table, assuming that only the out- come of a narrow list of so-called nutritionally sensitive infectious diseases is affected by chronic malnutrition. Both the prevalence and mortality rates of chronic diseases, such as congestive heart failure, can be affected by seriously impairing the physical func- tioning of the heart muscles, the lungs, the gastrointestinal tract, or some other vital organ systems other than the immune system. I will return to this issue in subsequent chapters. An important implication of Table 1.2 needs to be made ex— plicit. Today the typical American male in his early thirties is about 177 cm (69.7 inches) tall and weighs about 78 kg (172 pounds). Such a male requires daily about 1,794 calories for basal meta- bolism and a total of 2,279 calories for baseline maintenance.19 If either the British or the French had been that large during the eigh- teenth century, virtually all of the energy produced by their food supplies would have been required for maintenance, and hardly any would have been available to sustain work. The relatively small . .. THE PERSISTENCE 0F MISERY IN EUROPE AND AMERICA BEFORE 1900 Table 1.4 Estimated Average Final Heights (cm) of Men Who Reached Maturity between 1750 and 1975 in Six European Populations, by Quarter Centuries ( 1) Date of Maturity by (2) Century Great (3) (4) (5) (6) (7) and Quarter Britain Norway Sweden France Denmark Hungary 1. 18-Ill 165.9 163.9 168.1 169.1 2. 18-IV 167.9 166.7 163.0 165.7 167.2 3. 19-l 168.0 166.7 164.3 165.4 166.7 4. 19-ll 171.6 168.0 165.2 166.8 166.8 5. 19-III 169.3 168.6 169.5 165.6 165.3 6. 20—111 175.0 178.3 177.6 174.3 176.0 170.9 Sources and notes: Lines 1—5: Great Britain: all entries were computed from data in Floud, Wachter, and Gregory 1990. Norway: Floud 1984a, who cites Kiil 1939. Kiil estimated the height of recruits who were age 18.5 in 1761 at 159.5 cm, to which I added 4.4 cm to obtain the estimated final height 163.9 for 18—III. Sweden: Sandberg and Steckel 1987, Table 1. Decades straddling quarter centuries were given one—half the weight of decades fully within a quarter century. France: rows 3—5 were computed from von Meerton 1989 as amended by Weir 1993, with 0.9 cm added to allow for additional growth between age 20 and maturity (Gould 1869: 104—5; cf. Friedman 1982, p. 510 n. 14). The entry for row 2 is derived from a linear extrapolation of von Meerton’s data for 1815—36 back to 1788, with 0.9 cm added for additional growth between age 20 and maturity. Denmark: the entries are from Floud 1984a, who reported data analyzed by H. C. Johansen in 1982 and communicated privately. Hungary: all entries are from Komlos 1989, Table 2.1, p. 57. Line 6: the entry for Great Britain is from Rona, Swan, and Altman 1978, Table 3. The entries for Norway, Sweden, and Denmark are from Chamla 1983, Tables VII, XII, and XIV. Norwegian and Swedish heights are for 1965, Danish heights are for 1964. The entries for France and Hungary are from Eveleth and Tanner 1976, p. 284 (cf. p. 277). food supplies available to produce the national products of these two countries about 1700 suggest that the typical adult male must have been quite short and very light. This inference is supported by data on stature and weight that have been collected for European nations. Table 1.4 provides es-l timates of the final heights of adult males who reached maturity between 1750 and 1975. It shows that during the eighteenth and nineteenth centuries, Europeans were seVerely stunted by modern standards (cf. line 6 of Table 1.4). 14 THE ESCAPE FROM HUNGER AND PREMATURE DEATH, 1700—2100 Table 1.5 A Comparison of the Average Daily Uses of Dietary Energy in England and Wales in 1700 and 1800 (all lines in millions of calories, except line 3) (3) (1) (2) 1700 1 800 1 700 Counterfactual 1. Total daily dietary energy consumed (production plus net imports) 2. Energy used to produce agricultural output 871 913 777 20,509 1 1,470 9,71 8 3. Energy productivity in agriculture 20.4 12.5 12.5 (the output/input ratio of dietary energy) 4. Energy consumed in the agricultural sector 7,731 6,804 7,042 5. Energy consumed outside of the 12,778 4,666 2,676 agricultural sector 6. Energy used to produce nonagricultural output 1,684 683 0 Note: The numerator of the output/input ratio in line 3 excludes imported calories. This table supersedes Table 5 in Fogel 1997. Source: Fogel, Floud, and Harris, n.d. Could the English and French of the eighteenth century have coped with their environment without keeping average body size well below what it is today? How Europeans of the past adapted their sin to accommodate their food supply is shown by Table 1.5, which compares the average daily consumption of calo- ries in England and Wales in 1700 and 1800 by two economic sectors: agriculture and everything else. Within each sector the es- timated amount of energy required for work is also shown. Line 3 presents a measure of the efficiency of the agricultural sector in the production of dietary energy. That measure is the number of calories of food output per calorie of work input.20 Column 1 of the table presents the situation in 1800, when calories available for consumption were quite high by prevail- ing European Standards (about 2,933 calories per consuming unit daily), when adult male stature made the British the tallest national population in Europe (about 168 cm or 66.1 inches at maturity) and relatively heavy by the prevailing European standards, averaging . 1 i a i g. l i 5 § i THE PERSISTENCE OF MISERY IN EUROPE AND AMERICA BEFORE 1900 about 61.5 kg (about 136 pounds) at prime working ages, which implies a body mass index (BMI) of about 21.8. The BMI, a mea- sure of weight standardized for height, is computed as the ratio of weight in kilograms to height in meters squared. Food was rela— tively abundant by the standards of 1800 because, in addition to substantial domestic production, Britain imported about 13 per- cent of its dietary consumption. However, as column 1 indicates, British agriculture was quite productive. English and Welsh farm- ers produced over 20 calories of food output (net of seeds, feed, inventory losses, etc.) for each calorie of their work input. About 44 percent of this output was consumed by the families of the agriculturalists.21 The balance of their dietary output, together with some food imports, was consumed by the nonagricultural sector, which con- stituted abOut 64 percent of the English population in 1801.22 Al- though food consumption per capita was about 6 percent lower in this sector than in agriculture, most of the difference was explained by the greater caloric demands of agricultural labor. Food was so abundant compared to France that even the English paupers and vagrants, who accounted for about 20 percent of the population c.1800, had about three times as much energy for begging and other activities beyond maintenance as did their French counterparts.23 The food situation was tighter in 1700, when only about 2,724 calories were available daily per consuming unit. The adjust— ment to the lower food supply was made in three ways. First, the share of dietary energy made available to the nonagricultural sector in 1700 was a third lower than was the case a century later. That constraint necessarily reduced the share of the labor force of 1700 engaged outside of agriculture. Second, the amount of energy avail— able for work per equivalent adult worker was lower in 1700 than in 1800, both inside and outside agriculture, although the shortfall was somewhat greater for nonagricultural workers. Third, the en- ergy required for basal metabolism and maintenance was lower in 1700 than in 1800 because people were smaller. Compared with 1 800, adult heights of males in 1700 were down by 3 cm, their BMI was about 21 instead of 22, and their weights were down by about 16 THE ESCAPE FROM HUNGER AND PREMATURE DEATH, 1700—2100 4 kg. Constriction of the average body size reduced the number of calories required for maintenance by 105 calories per consuming unit daily. The last figure may seem rather small. However, it accounts for half of the total shortfall in daily caloric consumption.24 That fig- ure is large enough to sustain the proposition that variations in body size were a principal means of adjusting the population to variations in the food supply. The condition for a population to be in equilibrium with its food supply at a given level of consump— tion is that the labor input (measured in calories of work) is large enough to produce the requisite amount of food (also measured in calories). Moreover, a given reduction in calories required for main- tenance will have a multiplied effect on the number of calories that can be made available for work in the national income sense. The multiplier is the inverse of the labor force participation rate (work- ers per person in the population). Since only about 35 percent of equivalent adults were in the labor force, the potential daily gain in calories for NIPA work was not 105 calories per equivalent adult worker but 300 calories per equivalent adult NIPA worker.25 The importance of‘the last point is indicated by considering columns 2 and 3 of Table 1.5. Column 2 shows that the daily total of dietary energy used for NIPA work in 1700 was 1,596 million calories, with 913 million expended in agriculture and the bal— ance in nonagriculture. Column 3 indicates what would have hap— pened if all the other adjustments had been made but body size remained at the 1800 level, so that maintenance requirements were unchanged. The first thing to note is that energy available for food production would have declined by 15 percent. Assuming the same input/output ratio and amount of imports, the national supply of dietary energy would have declined to 9,718 million calories, of which over 70 percent would have been consumed within the agri- cultural sector. The residual available for nonagriculture would not even have covered the requirements of that sector for basal metabolism, leaving zero energy for NIPA work in nonagriculture. In this example, the failure to have constrained body size would have reduced the energy for NIPA work by about 51 percent.26 3 i THE PERSISTENCE OF MISERY IN EUROPE AND AMERICA BEFORE 1900 Ohio 178 National ‘77 Guard A 176 \ a E 175 113 171 d lnterpolated from ‘ ,c<—’ Ohio National 170 .4 Guard 169 1710 1730 1750 1770 1790 18101830 1850 1870 1890 1910 1930 1950 1970 YearofBirth S 60 I.) O0 4: ‘a‘ 55 5‘ g 8 . 3‘ 50 From Registration in Data (Includes i: Foreign-Born) 45 1710 1730 1750 1770 1790 1810 1830 1850 1870 1890 1910 1930 1950 1970 Year Figure 1.2 Trend in Mean Final Height of Native-Born White Amer- ican Males and Trend in Their Life Expectancy at Age 10. Sources: Fogel 1986; Costa and Steckel 1997. Note: Height is by birth cohort, and life expectancy at age 10 is by period. Varying body size was a universal way that the chronically mal- nourished populations of Europe responded to food constraints. However, even the United States, which was awash in calories compared with Europe, suffered from serious chronic malnutri- tion, partly because the high rate of exposure to infectious diseases prevented many of the calories that were ingested from being me- tabolized and partly because of the large share of dietary energy expended in NIPA work. Figure 1.2 summarizes the available data on U.S. trends in statute (which is a sensitive indicator of the nutritional status and health of a population) and in life expectancy since 1720. Both series contain striking cycles. They both rise during most of the 18 THE ESCAPE FROM HUNGER AND PREMATURE DEATH, 1700—2100 eighteenth century, attaining substantially greater heights and life expectancies than prevailed in England during the same period. Life expectancy began to decline during the 17905 and continued to do so for about half a century. A new rise in heights, the one with which we have long been familiar, probably began with co- horts born during the last decade of the nineteenth century and continued down to the present.27 Figure 1.2 reveals not only that Americans achieved modern heights by the middle of the eighteenth century, but also that they reached levels of life expectancy not attained by the general pop- ulation of England or even by the British peerage until the first quarter of the twentieth century. Similar cycles in height appear to have occurred in Europe. For example, Swedish heights declined by 1.4 cm between the third and fourth quarters of the eighteenth century. Hungarian heights declined more sharply (2.4 cm) between the third quarter of the eighteenth century and the first quarter of the nineteenth century. There also appears to have been regular cycling in English final heights (heights at maturity) throughout the nineteenth century, al- though the amplitude of these cycles was more moderate than those of the United States or Hungary. A second height decline, which was accompanied by a rise in the infant mortality rate, occurred in Sweden during the 18405 and 18503.28 This evidence of cycling in stature and mortality rates during the eighteenth and nineteenth centuries in both Europe and America is puzzling to some investigators. The overall improvement in health and longevity during this period is less than might be expected from the rapid increases in per capita income indicated by national in- come accounts for most of the countries in question. More puzzling are the decades of sharp decline in height and life expectancy, some of which occurred during eras of undeniably vigorous economic growth.” The prevalence of meager diets in much of Europe, and the cy- cling of stature and mortality even in a country as bountiful in food as the United States, shows how persistent misery was down almost to the end of the nineteenth century and how diverse were , .wWflmxwqu-weim i i; i E E- , THE PERSISTENCE 0F MISERY IN EUROPE AND AMERICA BEFORE 1900 19 the factors that prolonged misery. It is worth noting that during the 18805 Americans were slightly shorter than either the English or the Swedes, but a century earlier the Americans had had a height advantage of 5 to 6 cm over both groups. This conflict between vig— orous economic growth and very limited improvements or reversals in the nutritional status and health of the majority of the popula— tion suggests that the modernization of the nineteenth century was a mixed blessing for those who lived through it. However, the in— dustrial and scientific achievements of the nineteenth century were a precondition for the remarkable achievements of the twentieth century, including the unprecedented improvements in the condi- tions of life experienced by ordinary people. 2 Why the Twentieth Century Was So Remarkable Research during the past two decades has produced significant advances in the description and explanation of the secular decline in mortality. Although many of these findings are still ten- tative, they suggest a new theory of evolution that Dora Costa (an economist and biodemographer at MIT) and I call “techno- physio evolution.” Studies of the causes of the reduction in mortal— ity point to the existence of a synergism between technological and physiological improvements that has produced a form of human evolution that is biological but not genetic, rapid, culturally trans- mitted, and not necessarily stable.1 This process is still ongoing in both rich and developing countries. In the course of elaborating this theory, thermodynamic and physiological aspects of economic growth will be defined, and their impact on economic growth rates will be discussed. Unlike the genetic theory of evolution through natural selec- tion, which applies to the whole history of life on earth, techno- physio evolution applies only to the past 300 years of human his- tory and particularly to the past century.2 Despite its limited scope, 20 {, E g V. i K i i g i l; E i: i i. i WHY THE TWENTIETH CENTURY WAS 80 REMARKABLE technophysio evolution appears to be relevant to forecasting likely trends over the next century or so in longevity, the age of onset of chronic diseases, body size, and the efficiency and durability of vital organ systems. It also has a bearing on such pressing issues of public policy as thegrowth in population, in pension costs, and in health care costs. The theory of technophysio evolution rests on the proposition that during the past 300 years, particularly during the past century, human beings have gained an unprecedented degree of control over their environment — a degree of control so great that it sets them apart not only from all other species, but also from all previous gen— erations of Homo sapiens. This new degree of control has enabled Homo sapiens to increase its average body size by over 50 percent and its average longevity by more than 100 percent since 1800, and to greatly improve the robustness and capacity of vital organ systems. Figure 2.1 helps to point up how dramatic the change in the control of the environment after 1700 has been. During its first 200,000 or so years, Homo sapiens increased at an exceedingly slow rate. The discovery of agriculture about 11,000 years ago broke the tight constraint on the food supply imposed by a hunt- ing and gathering technology, making it possible to release between 10 and 20 percent of the labor force from the direct production of food and also giving rise to the first cities. The new technology of food production was so superior to the old one that it was pos- sible to support a much higher rate of population increase than had existed prior to c. 9000 B.C. Yet, as Figure 2.1 shows, the ad- vances in the technology of food production after the second Agri- cultural Revolution (which began about A.D. 1700) were far more dramatic than the earlier breakthrough, since they permitted the population to increase at so high a rate that the line of population appears to explode, rising almost vertically. The new technologi- cal breakthroughs in manufacturing, transportation, trade, com— munications, energy production, leisure-time services, and medical services were in many respects even more striking than those in 22 THE ESCAPE FROM HUNGER AND PREMATURE DEATH, 1700—2100 Stem Cell Research Population (in millions) Approved in US' Dolly the Cloned Sheep 6,000 B. Genome Project PC 8 Man on Moon _ Nuclear Energy High—Speed Computers ‘ 5,000 I Disc. DNA War on Malaria P _ .11_ enter in I. Airplane 4,000 Disc. New Worldl 1. Automobile Black Death 1". Peak of Romei'l‘. 3,000 v Peak of Greece. E“ ‘I e . I I I‘I i g} a” l g .I', _ f I. Telephone v0“ wot E : -|‘. ‘ Electrification 2,000 \0‘N . 090“ i i‘. : \-. petites : - “a E ; RS‘ C‘ (fith : : 2", Germ Theory : z E: 6.w€‘.ixflg : : \l‘ I B. Railroads 1,000 igtwt‘ warm : 1. Watt Engine -' .I :II 1: :1 ‘ ' B.Indust. Rev. I : : i ii I ’ “B. 2nd Ag. Rev. 0 Time -9000 -6000 -4000 -2000 0 2000 (in years) -5000 -3000 4000 1000 Figure 2.1 The Growth of World Population and Some Major Events in the History of Technology. Sources: Cipolla 1974; Clark 1961; Fagan 1977; McNeil] 1971; Piggott 1965; Derry and Williams 1960; Trewartha 1969. See also Allen 1992, 1994; Slicher van Bath 1963; Wrigley 1987. Note: There is usually a lag between the invention (1) of a process or a machine and its general application to production. "Beginning" (B) usually means the earliest stage of this diffusion process. agriculture. Figure 2.1 emphasizes the huge acceleration in both population and technological change during the twentieth century. The increase in the world’s population between 1900 and 1990 was four times as great as the increase during the whole previous history of humankind. WHY THE TWENTIETH CENTURY WAS so REMARKABLE 23 The Relationship between Body Size and the Risk of Death at Middle and Late Ages Although Figure 2.1 points to changes in technology that permit— ted a vast increase in population, it does not reveal a connection between technological changes and physiological benefits. To get at that question, we need to consider a number of recent studies that have demonstrated the predictive power of height and body mass with respect to morbidity and mortality at later ages. The re— sults of two of these studies are summarized in Figures 2.2 and 2.3. Figure 2.2 plots the relationship between relative mortality risk and height found by Hans Waaler among Norwegian men aged 40—59 measured in the 19605 and among Union Army veterans measured at ages 23—49 and at risk between ages 55 and 75.3 Short men, whether modern Norwegians or nineteenth—century Americans, were much more likely to die than tall men. Height Relative Risk 68 70 72 74 76 78 80 Height (inches) Figure 2.2 Relative Mortality Risk among Union Army Veterans and among Modern Norwegian Males. Note: A relative risk of 1.0 means that the risk at that height was equal to the average risk of death in the entire population of males of the specified ages. Also note that the tallest data point, in both the Norwegian and Union Army cases, is not statistically significant. 62 64 66 ...
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ESCAPE FROM HUNGER AND PREMATURE DEATH - The Escape from...

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