The Changing Body: Health, Nutrition, and Human Development in the Western World since 1700

Published by EH.NET (December 2011)

Roderick Floud, Robert W. Fogel, Bernard Harris and Sok Chul Hong, The Changing Body: Health, Nutrition, and Human Development in the Western World since 1700. Cambridge: Cambridge University Press, 2011. xxvi + 431 pp. $33 (paperback), ISBN: 978-0-521-70561-5.

Reviewed for EH.Net by Tomas Cvrcek, Department of Economics, Clemson University.

If you care about the quality of life of yourself in old age and of your descendants over the next few generations, I am pleased to report that the authors of The Changing Body have mostly good news for you. (More on that later.)

This book is a result of several decades of research into the interaction between economic development and human biology. The reader will revisit all the important debates closely or loosely connected with the historical record of living standards: these include the ?antebellum puzzle,? the ?industrious revolution? and the amount and intensity of work supplied, the McKeown (1976) debate about the relative importance of nutrition in the decline of mortality, and ? inevitably ? the mother of all these feuds, the pessimists versus optimists vis-?-vis living standards during the British Industrial Revolution.

The book outlines in great detail the idea of technophysio evolution, a concept that has been around for some time but which, in this book, gets a more thorough treatment. The authors summarize it at the outset into four propositions: that the nutritional status of a generation determines how productive that generation is going to be and for how long (how long it will live); that this fact in turn affects their actual production and hence living standards; that these factors tend to cast a VERY long shadow so that each generation is also affected by choices made by their parents and grandparents (both as a generation and within each family line); and, inevitably, that each generation in turn affects the living standards of many cohorts in the future.

The first three chapters are devoted to laying the groundwork. The authors rely on historical data on heights, weights, mortality and food consumption (its amount and distribution). They show that even when average nutrition values look sufficient for the population, the inequality in its consumption may mean ? as was the case in France just before the Revolution ? that up to 20% of adults were not sufficiently nourished to perform any sustained work and that the bottom decile were basically slowly (or quickly) starving to death (p. 54). They discuss the relationship between body size and mortality because this has a direct bearing on the debate on causes of the mortality decline in the nineteenth century. The researchers split the mortality decline into movements along the Waaler surface (i.e. improvements due to improved stature via better nutrition) and movements of the surface (the improved chances of survival at any given BMI due to, say, medical intervention and health policy) and after much careful pro and con come down more or less on the side of Thomas McKeown, i.e. assigning more weight to better nutrition in the early nineteenth century while acknowledging the importance of various public health programs and initiatives in the later period (pp. 152-64).

The second part of the book (chapters 4-6) is organized territorially. Chapter 4 deals with England and Wales and draws on numerous data sources, including Bob Allen?s real wages, Floud and Wachter?s (and many others?) height data, Wrigley and Schofield?s demographic data, etc. They show that while real wages fell in late eighteenth century and while the mortality decline stalled in early nineteenth century (p. 145), the English still had it better than Continental Europeans and that their better nutritional status accounted for about a third of the 1.2% annual growth over the course of the last two hundred years (p. 128).

Chapters 5 and 6 deal with continental Europe and with the United States. The authors are able to marshal compelling evidence on mortality decline and it is in this chapter that a large part of their argument about intergenerational transmission of the biological standard of living is made. It turns out that mortality decline has a strong cohort component: it first starts falling for people aged 5-10, then a decade later for teenagers, another decade later for twenty-somethings and so on (p. 242-58). This naturally invites explanations focusing on early childhood (or even in utero) insults and on the living standard of parents.

Many assertions in this book will not be new to those working in the field because they have been published and debated for some time now. The hallmark of the book, however, is its relentless focus on detail (where the devil is) and the gradual building up of the case for the big-think claims. On that score, the very-long-term effect of health investments (and injuries) is perhaps the most intriguing statement in the book: it implies that every generation is at the receiving end of a massive externality ? negative in some historical cases but positive in the case of our times.

This last bit finally brings me on to the good news, mentioned at the beginning. Hopelessly Whiggish as this may sound, the overall long-term record emerging from this book is one of undeniable improvement. The health status of the populations living in the developed world has been trending upwards and looks like it will continue to do so. Life expectancy is increasing and the proportion of life that is mostly free of serious health concerns (the healthy-life expectancy, HLE) is also increasing. This is because we reap the benefits of the various decisions of our ancestors. So, if you live long (and chances are you will), thank your mother. And your grandmother. And? (you get the idea).

Tomas Cvrcek has published papers on the biological standard of living under Communism in Economics and Human Biology and in Explorations in Economics History. tcvrcek@clemson.edu

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