------------ EH.NET BOOK REVIEW --------------
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 =D3 Gr=E1da, 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 =D3 Gr=E1da 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_.
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Published by EH.Net (October 2004). All EH.Net reviews are archived
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