Well-Being for Most of Human History (and Fogel's "Escape from Hunger and Premature Death ...")4

It's hard to convince students about the improvements in well-being over the last 300 years. I joke that most students impression of the pre-industrial society was that it was like The Shire in the movies. (Heck, many literary theorists have argued that this is the view that Tolkien had a century ago when he was beginning to imagine an idyllic world where humans were less important). 

Yeah ... not so much. 

A more informed analysis is in Nobel-prize winner Robert Fogel's book The Escape from Hunger and Premature Death, 1700-2100: Europe, American and the Third World (not required, but yes, the SUU library has a copy). The book is based on lectures given in the late 90's.

This is a fascinating look at how the quality of human health has changed over the past 300 years, and is likely to change in the future. We have gone from being stunted and disease prone to being larger, more robust, and relatively disease free. Fogel argues that the primary reason for this is not improved medical or public health care, but rather improved nutrition brought about by economic growth. He sees health care as the growth industry of the 21st century - now that we have enough to eat we can afford the luxury of medicine.

The whole book is really an in depth analysis of the thesis of:

Thomas McKeown (1911-1988) received his Ph.D. from Cambridge University and from 1950 to 1978 was Professor of Social Medicine at the University of Birmingham Medical School.  He was a major historian of medicine and put forth the influential and controversial McKeown Thesis, which argued that the growth in world population after 1700 was not due primarily to the increase in lifesaving medicine or public health policies, but rather to improvements in overall standards of living resulting from better economic conditions, especially nutrition. [pg. 152]

McKeown attacked the consensus view of declining mortality rates:

Between the late 1930s and the end of the 1960s a consensus emerged on the explanation for the secular trend.  A United Nations study published in 1953 attributed the trend in mortality to four categories of advances: (1) public health reforms, (2) advances in medical knowledge and practices, (3) improved personal hygiene, and (4) rising income and standards of living.  A United Nations study published in 1973 added “natural factors,” such as the decline in the virulence of pathogens, as an additional explanatory category.

A new phase in the effort to explain the secular decline in mortality was ushered in by Thomas McKeown, who, in a series of papers and books published between 1955 and the mid-1980s, challenged the importance of most of the factors that previously had been advanced for the first wave of the mortality decline.  He was particularly skeptical of those aspects of the consensus explanation that focused primarily on changes in medical technology and public health reforms.  In their place he substituted improved nutrition, but he neglected the synergism between infection and nutrition and so failed to distinguish between diet and nutrients available for cellular growth.  McKeown did not make his case for nutrition directly but largely through a residual argument after having rejected other principal explanations.  The debate over the McKeown thesis continued through the beginning of the 1980s.  However, during the 1970s and 1980s, in was overtaken by the growing debate over whether the elimination of mortality crises was the principal reason for the first wave of the mortality decline, which extended from roughly 1725 to 1825. [pp. 4-5]

Analysis of the data showed that mortality crises - like famines - were far more unimportant than thought previously.

Mortality was far more variable before 1750 than afterward.  They also revealed that the elimination of crisis mortality, whether related to famines or not, accounted for only a small fraction of the secular decline in mortality rates.  About 90 percent of the drop was due to the reduction of “normal” mortality. [pg. 6]

Rather, nutrition was appallingly poor prior to the modern period of economic growth:

…The energy value of the typical diet in France at the start of the eighteenth century was as low as that of Rwanda in 1965, the most malnourished nation for that year in the tables of the World Bank.  England’s supply of food per capita exceeded that of France by several hundred calories but was still exceedingly low by current standards.  Indeed, as late as 1850, the English availability of calories hardly matched the current Indian level. [pg. 8]

The supply of food available to ordinary French and English families between 1700 and 1850 was not only meager in amount but also relatively poor in quality.  …  One implication of these low-level diets needs to be stressed: Even prime-age males had only a meager amount of energy available for work. [pg. 9]

During the eighteenth century, France produced less than one-fifth of the current U.S. amount of energy available for work.  Once again, eighteenth-century England was more prolific, providing more than a quarter of current levels, a shortfall of well over 1,000 calories per day. Only the United States provided energy for work equal to or greater than current levels during the eighteenth and early nineteenth centuries. [pg. 11]

Food was so abundant compared to France that even the English paupers and vagrants, who accounted for about 20 percent of the population c.1800, had about three times as much energy for begging and other activities beyond maintenance as did their French counterparts. [pg. 15]

It also seems that the adage that what doesn't kill you makes you stronger is nothing more than words:

Young adults born between 1822 and 1845 who survived the deadly infectious diseases of childhood and adolescence were not freer of degenerative diseases than persons of the same ages today, as some have suggested, but were more afflicted. … The provisional findings thus suggest that chronic conditions were far more prevalent throughout the life cycle for those who reached age 65 before World War I than is suggested by the theory of the epidemiological transition.  Reliance on cause-of-death information to characterize the epidemiology of the past has lead to a significant misrepresentation of the distribution of health conditions among the living. [pg. 32]

Our quality of life is much higher as well. Our intentional exclusion of leisure from the national income and product accounts (because its value isn't easy to measure) leads to:

Of the roughly 25-hour reduction in the work week between 1860 and 1990, perhaps 5 or 6 hours were eliminated before 1890. … Kuznets, who was the leading designer of the U.S. national income accounts, recognized the large underestimate of economic growth occasioned by the omission of leisure from these accounts.  Valuing the increased daily hours of leisure of workers at the average wage, he pointed out, would raise per capita income in the late 1940s by about 40 percent.  Today, the figure would be closer to 120 percent. [pg. 38]

As a macroeconomist I know the following roll call, but it is always nice to see it reiterated:

Not only has productive technology changed dramatically, but the diffusion of modern technology has also accelerated greatly over the past two centuries.  Modern economic growth began first in Great Britain early in the eighteenth century.  It did not begin in the United States until the late eighteenth century.  France joined them after the Napoleonic era.  By the middle of the nineteenth century, the circle had expanded to include the Netherlands, Germany, Switzerland, Denmark, Norway, Sweden, Canada, and Australia.  Japan, Russia, and Argentina did not embark on the path of modern economic growth until the end of the nineteenth century.  For Italy and other West European nations, modern economic growth was delayed until the beginning of the twentieth century.  Except for Japan, modern economic growth did not extend to Asia until after World War II. [pg. 50]

Not only that, but we are better off in other ways as well:

Over the past century, technophysio evolution has permitted the average length of retirement to increase by five-fold, the proportion of a cohort that lives to retire to increase by seven-fold, and the amount of leisure time available to those still in the labor force to increase by nearly four-fold. [pg. 67]

Hence, leisure is not a synonym for indolence but a reference to desirable forms of effort or work (“work” is to be understood here in the physiological rather than the economic sense).  As George Bernard Shaw put it, “labor is doing what we must; leisure is doing what we like, and the rest is doing nothing whilst our bodies and our minds are recovering from their fatigue.”  To some extent presently, and more so in the future as the average work week declines toward 28 hours and retirement normally begins at age 55, these terms will lose their pejorative connotation. Work will increasingly mean activity under the compulsion of earning income, regardless of whether the effort is manual or mental.  And leisure will mean purely voluntary activity. [pp. 69-70]

Fogel then makes a jump that I'm not sure I can agree with; that we are moving out of an age dominated by the acquisition of things because:

In the case of television, there are 0.8 more sets per person (2.2 per household).  In some items such as radios, we seem to have reached supersaturation, since there is now more than one radio per ear (5.6 per household).  The level of saturation for many consumer durables is so high that even the poorest fifth of households are well endowed with them. [pg. 71]

Even though I am one of the folks who did the following:

A poll conducted in late 1995 reported that 48 percent of U.S. adult earnworkers had either cut back on hours of work, declined a promotion, reduced their commitments, lowered their material expectations, or moved to a place with a quieter life during the preceding 5 years.  What is at issue for such employees is time -- time to enjoy the things they have, time to spend with their families, time to figure out what life is all about, and time to discover the spiritual side of life. [pg. 72]

Of course, another one that economists know but that many others are in denial about is that:

Although the average annual hours of earnwork performed by household heads has continued to decline over the past quarter century, the combined hours of earnwork performed by households with husbands and wives present has increased by 24 percent since 1969.  These extra hours are concentrated in prime working ages, and they are one of the main ways that couples are financing early retirement. [pg. 73]

In the United States a century ago, it took about 1,700 hours of work to purchase the annual food supply for a family. Today it requires 260 hours.  If agricultural productivity grows at just two-thirds of its recent rates, then by 2040 a family’s annual food supply may be purchases with about 160 hours of labor. [pg. 90]

This has an interesting implication for the next century:

The point is that leisure-time activities (including lifelong learning) – volwork – and health care are the growth industries of the twenty-first century.  They will spark economic expansion during our age, just as agriculture did in the eighteenth and early nineteenth centuries and as manufacturing, transportation, and utilities did in the late nineteenth and much of the twentieth centuries. [pg. 73]

Generally I cross-post from my classroom blogs to my personal one, but in this case I mostly went the other way, re-using the long quotes I'd assiduously typed over there.