------------ 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_. 
 
Copyright (c) 2004 by EH.Net. All rights reserved. This work may be  
copied for non-profit educational uses if proper credit is given to  
the author and the list. For other permission, please contact the  
EH.Net Administrator ([log in to unmask]; Telephone: 513-529-2229).  
Published by EH.Net (October 2004). All EH.Net reviews are archived  
at http://www.eh.net/BookReview. 
 
-------------- FOOTER TO EH.NET BOOK REVIEW  -------------- 
EH.Net-Review mailing list 
[log in to unmask] 
http://eh.net/mailman/listinfo/eh.net-review