The Escape from Hunger and Premature Death, 1700-2100: Europe, America, and the Third World

Published by EH.NET (October 2004)

Robert William Fogel, The Escape from Hunger and Premature Death, 1700-2100: Europe, America, and the Third World. Cambridge: Cambridge University Press, 2004. xx + 191 pp. $70 (hardback), ISBN: 0-521-80878-2; $23.99 (paperback), ISBN: 0-521-00488-8.

Reviewed for EH.NET by Cormac ? Gr?da, Department of Economics, University College, Dublin.

Nobel laureate Robert Fogel dedicates his latest monograph to Sir Tony Wrigley and records his debt to the late Simon Kuznets (his “principal teacher in graduate school”) in the preface, and for good reason. Although Fogel is the prophet of the Cliometric Revolution, this short — 111 pages of text — and brilliant book owes somewhat more to quantitative economic history in the Kuznetsian tradition than to cliometrics per se. Fundamentally it is about measuring human welfare-related indices such as calorific intake, human stature and related anthropometric indices, life expectancy, a more comprehensive measure of consumption than GDP (which Fogel dubs “expanded consumption”), and body mass index (BMI) of past and present populations, and then spelling out the dramatic implications of such measurements for our understanding of both the past and prospects for the future.

Other important influences on the findings reported here — which are the product of over two decades of research — include Hans Waaler (epidemiologist), Thomas McKeown (medical historian), and Nevin Scrimshaw (nutritionist). That none of these scholars was (or is) an economist or an economic historian is a measure of Fogel’s interdisciplinary leanings. In a paper in a Norwegian journal that owes its fame (fully-deserved) to Fogel, Waaler used a large Norwegian dataset to highlight the U-shaped relationship between mortality and body mass index (BMI) and the reverse J-shaped relationship between mortality and adult height. McKeown argued, controversially and tenaciously, that better nutrition rather than medicine was responsible for pre-1950 improvements in life expectancy. Scrimshaw is best known for stressing the synergistic link between poverty and nutrition: since in the past illness and malnutrition constrained productivity, people were poor because they were poor. Over the past few centuries, however, advances in health, productivity, and technology have fed off one another, producing a virtuous circle of unprecedented improvements in human welfare. Fogel fleshes out these insights, and measures their implications for human welfare in the past, present, and future. In the process, he invokes a dazzling combination of anthropometric, nutritional, and demographic research findings, many due to his own work or those of his immediate collaborators and students.

Forget those fables about “the roast beef of Olde Englande” and their equivalents elsewhere: here (and in earlier work) Fogel confirms that for most of human history life for the masses was indeed “nasty, brutish, and short.” In pre-industrial Europe, although famine was less murderous than sometimes claimed, malnutrition was endemic even in relatively advanced economies (Fogel 1994). Malnutrition presumably constrained fecundity and marital fertility (a point not spelled out). While Fogel dates the take-off into modern economic growth conventionally, his findings and their emphasis on “technophysio evolution” (a product of the interaction between technological and physiological progress) single out the advances made in the late nineteenth and twentieth centuries. A key point is that before then health insults in infancy and early childhood impacted significantly on life expectancy and morbidity in middle age. Improvements in public health technology in the late nineteenth and early twentieth centuries — mainly through improved water and milk quality, better hygiene, and improvements in obstetric and neo-natal health care — greatly reduced such insults in the developed world, with consequent beneficial impact on chronic diseases and life chances of the middle-aged and elderly today. During the twentieth century the average number of “chronic conditions” (these are listed on p. 31) per U.S. sexagenarian fell by over two-thirds. These changes also increased both average birth weights and average adult heights. The singularity of the past century is made plain in Figure 2.1 (which will already be familiar to many readers), its reverse L-shape describing secular population growth.

As Escape from Hunger explains, biomedical and economic measures of welfare and distribution do not always tally. A well-known example concerns the antebellum U.S. where wage data indicate considerable variation by region and occupation, but significant growth everywhere in the antebellum period (Margo 2000: Tables 3A-9 to 3A-11). The mean adult height and life expectancy of population cohorts born in that era fell, however (p. 17). The case of living standards in Britain during the Industrial Revolution is analogous (1790-1860). Here Fogel reminds us that while wage data support a cheerful view of the impact of early industrialization on British workers, anthropometric research argues for a more pessimistic stance. Building on and refining earlier findings by Jeff Williamson, Fogel notes that if one takes account of the rise in mortality in the industrializing towns of Britain before the mid-nineteenth century, half or so of the supposed rise in real wages turns out to have been “spurious’ (pp. 35, 133). In the twentieth century, anthropometric, demographic, and economic measures all rose exponentially. However, the significant increase in human welfare due to the rise in life expectancy during the twentieth century is not captured by national accounts.

The second adjustment concerns leisure. A key finding (already reported in Fogel 2000) is that in the U.S. the consumption of leisure accounted for over two-thirds of what Fogel dubs “expanded consumption” today, up from less than one-fifth in 1875 (pp. 88-89). This is due to a combination of shorter hours at work and increased life expectancy. The story is the same for other post-industrial economies. The staggering share of leisure stems from valuing it in terms of other consumption foregone. That share is set to rise, as are those of education and, as already noted, healthcare. Fogel also makes a Veblenesque distinction between “earnwork” and “volwork,” or between work that one needs to do to earn a living, and work that is purely voluntary, even if it carries a financial return. The ratio of the former to the latter was over four-to-one in the U.S. in 1880; it is about two-to-three today, and is set to fall to one-to-three by 2040 (pp. 70-71).

Some of us study the past for its own sake; more of us are eager to invoke the past for the light it throws on the present; but here Fogel invokes the past to forecast the future. He predicts that the proportion of income devoted to healthcare is set to rise, particularly in developing economies. In the U.S. healthcare is set to cost a staggering 21 per cent of GDP by 2040 (p. 89). This is less because of Baumol’s Law than because improvements in costly health technology are likely to continue and because the demand for healthcare is highly income-elastic.

In the end, although Africa and AIDS temper its predictions and policy recommendations, this is an optimistic book from one of the dismal science’s masters. Fogel’s concern for the poor and the sick — both in developed and undeveloped nations — is patent throughout, and he clearly prefers less global inequality to more. Hence his proposals for the reform of medicare in the First World, and his pleas for more funding for R&D on diseases such as HIV/AIDS and for the prevention and treatment of such diseases in the Third World. Meanwhile, in OECD economies the demand for consumer durables such as cars and TVs has nearly reached saturation point. However, Fogel believes that improvements in food and health technologies are likely to increase human life expectancy — and therefore potential output — considerably, even in the developed world, in the twenty-first century. The predicted gap between the demand for and potential supply of goods implies, controversially, that the days of Stefan Burenstam Linder’s Harried Leisure Class (1971) — constrained by time to stint on the material and physic pleasures available to it — are numbered. If Fogel is right, then one of humanity’s challenges in the twenty-first century will be “earthly self-realization,” that is, how to make the most of the leisure time available to it.

The book contains a useful, albeit short glossary of technical terms (e.g. basal metabolism, BMI, income elasticity), but the definitions of terms devised by Fogel himself (e.g. technophysio evolution, volwork, Waaler surface) are always found in the text. There are brief biographies of some of the researchers mentioned (pp. 151-54). Escape from Hunger is without a doubt one of Fogel’s masterworks. Written in an accessible style, it is ideal for use in higher-level undergraduate and graduate courses. One small gripe: was this the right place for ten pages of Tables A2 and A3 (pp. 116-25) describing the data underlying the “Waaler surface” in the frontispiece?

References:

Robert W. Fogel, 1994. “Economic Growth, Population Theory and Physiology: The Bearing of Long-term Processes on Economic Policy,” American Economic Review, 84(3): 369-95.

Robert W. Fogel, 2000. The Fourth Great Awakening and the Future of Egalitarianism, Chicago: University of Chicago Press.

Robert A. Margo, 2000. Wages and Labor Markets in the United States, 1820-1860, Chicago: University of Chicago Press.

Cormac ? Gr?da teaches at University College Dublin. His last monograph was Black ’47 and Beyond (Princeton, 1999). He has almost completed Jewish Ireland in the Age of Joyce: A Social Science History, and is working on Famine: A Short History.