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Rising Life Expectancy: A Global History

Author(s):Riley, James C.
Reviewer(s):Easterlin, Richard A.

Published by EH.NET (February 2002)

James C. Riley, Rising Life Expectancy: A Global History. New York:

Cambridge University Press, 2001. xii + 243 pp. $50 (hardback), ISBN:

0-521-80245-8; $17 (paperback), ISBN: 0-521-00281-8

Reviewed for EH.NET by Richard A. Easterlin, Department of Economics,

University of Southern California.

Economic historians, who have been backing into life expectancy by way of

stature, will find this book of interest. It is a qualitative survey of the

nature and causes of increasing life expectancy since 1800. Today, global life

expectancy at birth is about 67 years; two centuries ago it was 30 years or

less. The first fifth of this book describes briefly the temporal and spatial

features of this “health transition.” The remainder is devoted to individual

chapters on six possible causes: (1) public health, (2) medicine, (3) wealth,

income, and economic development, (4) famine, malnutrition, and diet, (5)

households and individuals, and (6) literacy and education. In the author’s

words:

Two main arguments are developed . . . . The first . . . is that individual

countries . . . devise their own strategies for reducing mortality. People have

always selected from the same six tactical areas [listed above]. . . . But

different countries have used those means in different ways . . . .

The second . . . deals with the implications of having extended survival in

this way . . . . [On the plus side] [t]he multiplicity of tactics . . . are

accommodations to the different characteristics and preferences of people . . .

. [On the negative side] old schemes are often maintained even as new schemes

are being adopted [and] . . . strategies that limit risks to survival and

foster the good health of a population may be remarkably inefficient (pp.

x-xii).

A great strength of this book is its global approach. Riley, professor of

history at Indiana University, is not constrained by the geographic paradigm

that dominates economic history (Britain, France, Germany, U.S., Russia, Japan,

and perhaps a few others). He sees the spread of rising life expectancy as a

continuous worldwide process, and in chapter after chapter strives assiduously

to include developing along with developed countries. The text, footnotes, and

end-of-chapter references provide valuable entr?e, not only to a vast

historical literature, but also to much contemporary work in demography and

public health, as well as that by specialists at the World Health Organization

and World Bank.

Riley sees parallels between the health transition and modern economic growth,

and laments the casual concern with the causes of life expectancy compared to

those of economic growth. For economic historians who still believe that

economic development is the prime mover behind life expectancy, this is a

non-issue. But Riley seemingly believes that development is not a very

important cause of increased life expectancy (chapter 4). I think he is right,

though, surprisingly, reference to the adverse impact on mortality of

development-induced urbanization is in chapters other than that on economic

development (pp. 148, 175). Indeed, if economic historians came to see both

modern economic growth and life expectancy as analogous phenomena, each driven

by advances in different areas of knowledge and technology, they might benefit

from comparative study of the two. Riley’s book would be a help in such study.

Although a useful survey, this is, at the same time, a frustrating book. While

accepting the concept of an industrial revolution, Riley rejects this

term for the breakthrough in life expectancy. “[T]he health transition has no

well-defined beginning point. It . . . was underway by 1800, but the discovery

of a period or country where it began is a quite difficult matter” (p. 6). Here

I think Riley is wrong. It is relatively easy to date the onset of a

revolutionary rise in life expectancy in country after country. (See Richard A.

Easterlin, “How Beneficent is the Market? A Look at the Modern History of

Mortality,” European Review of Economic History, 3 (1999), pp. 262-264.)

By contrast, views on the timing of the onset of economic growth differ

greatly; as an example, Rostow dates Britain at 1783-1830 and Sweden at

1868-1890, whereas Maddison puts them both at 1820.

The book is frustrating too because of its emphasis on the variability among

countries in routes to rising life expectancy. Riley’s statement that “[p]eople

have always selected from the same six tactical areas . . . [b]ut different

countries have used those means in different ways” gives the impression that

all six sources of life expectancy increase have been equally important, and

countries could virtually choose at random the mix they wished to use. In fact,

the opposite is the case. The critical breakthroughs that have made possible

the worldwide revolution in life expectancy are public health and medicine,

Riley’s categories (1) and (2). Absent the transformation in health production

functions arising from these sources, categories (3) through (6) would not have

transformed health and life expectancy. All countries that have experienced a

marked increase in life expectancy have done so by implementing a new

technology of disease control via new institutions, centering on, but not

confined to, a public health system. The role of public initiative has been

central in this transformation in all countries — “households and individuals”

and “literacy and education” in themselves would have been of little importance

had it not been for public action to disseminate new knowledge of disease

control and promote new household and business practices to implement this

knowledge. Nowhere is this clearer than in the biggest single accomplishment

improving health and mortality, the eradication of smallpox, which required

concerted action by national and international authorities (cf. p. 71). To the

extent there have been “different paths” followed by countries, it is largely

because of differences in the state of knowledge at the time of onset of the

“health transition.” Britain is charged by Riley with a costly emphasis on

sanitation that today’s developing countries could and should avoid. But

Britain’s path reflects the state of biomedical knowledge at the time (along

with Britain’s relatively high level of urbanization). It’s as though one would

chide Britain for its costly nineteenth century emphasis on a technology of

steam-powered railroads and factories, rather than using motor vehicles and

electric motors.

I suspect Riley would agree with this view of the causal primacy of public

health and medicine, because one can find support for much of it in the

chapters on the “six tactical areas.” But by emphasizing variability rather

than commonalities among countries, Riley downplays the central role in raising

life expectancy of new knowledge, and public action to implement this

knowledge, in country after country.

In sum, this book is a useful starting point for understanding the modern

revolution in mortality. But economic historians will want to go farther to

identify and quantify the uniformities among countries in the rise of life

expectancy and in the requirements of labor, capital, and new institutions

underlying this rise, and to test models of causation.

Richard A. Easterlin is University Professor and Professor of Economics at the

University of Southern California. He is the author of Growth Triumphant:

The Twenty-First Century in Historical Perspective (Ann Arbor: University

of Michigan Press, 1996).

Subject(s):Historical Demography, including Migration
Geographic Area(s):General, International, or Comparative
Time Period(s):20th Century: WWII and post-WWII