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).