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 entrée, 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).