The Escape from Hunger and Premature Death, 1700-2100: Europe, America, and the Third World
by Robert William Fogel, Jan De Vries, Paul Johnson, Richard Smith, Ke Wrightson

From the Publisher

Nobel laureate Robert Fogel’s compelling new study examines health, nutrition and technology over the last three centuries and beyond. Throughout most of human history, chronic malnutrition has been the norm.

During the past three centuries, however, a synergy between improvements in productive technology and in human physiology has enabled humans to more than double their average longevity and to increase their body size by over fifty percent. Larger, healthier humans have contributed to the acceleration of economic growth and technological change, resulting in reduced economic inequality, declining hours of work and a corresponding increase in leisure time.

Increased longevity has also brought increased demand for health care. Fogel argues that health care should be viewed as the growth industry of the twenty-first century and systems of financing it should be reformed. His book will be essential reading for all interested in economics, demography, history and health care policy.

Review by Victor Niederhoffer, Daily Speculations

I am indebted once again to the best eye for economics in the 20th century, James Lorie, for introducing me to the cliometrician Robert Fogel, with the comment " His work is brilliant and important". Thus, when I saw a reference to Robert Fogel's 111 page work, The Escape from Hunger and Premature Death, 1700-2100, published in 2004, I was predisposed to give it a read. It is one of the most rewarding and mind boggling short works I have ever read, and I would recommend it to all as a startling shooting star of light on the subject of the records, causes and prospects for longevity, as a beacon of proper methodology for historical studies, a debunker of numerous market fallacies, and a guide for proper thinking of about the industries most likely to prosper in the coming decades.

The main point of the book is that there has been an unprecedented increase of 15 years of life span per person in the last 100 years, for all countries, and that the gains have been much greater for the poor and underdeveloped, mostly coming from the combined co-evolution of better technology and better nutrition.

Fogel has the ideal background to be a cliometrician. He started out as a science major at Stuyvesant, then went into physical sciences at Cornell and History at John Hopkins, where he learned everything then known about economic time series. After 10 years working for his dad's meat packing business, (his dad was a frustrated engineer -- having emigrated penniless from Czarist Russia and having started out below the minimum wage as a janitor), he thought he could solve the problems of why the economy was not at full employment. Then he figured he better study smaller things first, like railroads and steel's contribution to human progress. Along the way, he fought the battle with traditional statisticians and began to study the rate of return from slavery, based on discussions deriving from a classic paper by John Myers. In the course of studying it, he had to figure out what was known about life expectancies in the 18th and 19th centuries. He found several data bases in Union Army annals, and in Norway, that enabled him to construct time series to shed light on these life expectancies. Strangely he found cycles of increasing and decreasing life expectancy in the 19th century; just a temporary decline from various famines, a slight increase from the beginning of mankind to the end of the 18th century, and then a massive increase in the 20th century.

Fogel describes the central message of the book as technophysio evolution -- the synergistic interaction between advances in the technology of production and improvements in human physiology. This evolution led to about a 30 year increase in life expectancy in the 20th century, 13 years in the 19th century and hardly any increase in the thousands of years before that.

whatever contributions the technological and scientific advances of the eighteenth and 19th centuries may have made, escape from hunger and high mortality did not become a reality for most ordinary people until the twentieth century.
Fogel attributes this to the improved productivity of agriculture which gave humans more calories to consume, and thus energy available for work. He places much reliance on global balance sheets of energy available as calories, less the amount needed for metabolism. There was not much left, on average, before the 19th and 20th century improvements in mechanization and transportation, refrigeration and communication.

Fogel believe that the increase in calories gives people a better change of having the right height relative to weight, the body mass index, which is height squared divided by weight. There are many interesting cross sectional tables that show that mortality is greater when the body mass or proper height is not reached.

There are several great leaps of faith in making this argument of causation of the decrease in mortality from these factors. I do not believe that the alternative explanation of better hygiene, and better antibiotics , i.e. better medicine, is adequately tested nor that longitudinal comparisons of causes over time can be based on cross sectional differences at any given time.

The second chapter of the book is devoted to why the twentieth century was so remarkable. Fogel notes that during our first 20,000 years, humans population increased at an exceedingly slow rate. The move from hunting to agriculture 11,000 years ago "made it possible to relieve 15% of the labor force from the direct production of food and gave rise to the first cities", yet the advances in the technology of food production after the second agricultural revolution of 1700 were far more dramatic than in the first. The new technology's breakthroughs in manufacturing, transportation, trade, communications ,energy production ,leisure time services and medical services, were in many respect even more striking than those in agriculture. Fogel in chapter 2 gives a beautiful chart of all the improvements of the 19th century, including airplanes, automobiles, penicillin, the discovery of DNA, nuclear energy, computers, cloning, the war on malaria, the man on moon, the genome project, and stem cell research, to prove that the 20th century had a much greater string of advances than other centuries (which look relatively lack luster with just 2 or 3 advances a century at most). But as in so much of chart work, the qualitative enumeration is subject to much debate as others could argue that the the 19th and 18th century were equally important and adduce charts that would look just as convincing.

The second chart in chapter two is crucial to the author's argument. It shows that the relative mortality risk of Union Army Veterans at 64, 68 and 72 inches is 1.3 to 1 to 0.5 respectively. Similar, but not as strong results apply to relative mortality risk by body mass index, but here a bmi near the middle is very good, with a 0.9 relative risk -- and as you get up to 30 or down to 20 the relative risk goes up by some 100%.

At this point Fogel's training in mechanical drawing at Cornell comes into play and he lovingly presents and describes a Waaler diagram of Iso-Mortality Curves of Relative Risk for Height and Weight among Norwegian males aged 50-64 with a Plot of the Estimated French Height and Weight at four dates superimposed. Such a diagram is a nice example of visual statistics, but it is so crowded and hard to read and based on so few observations at the sharply up sloping points, that it is easy to be mislead. As always, I prefer the raw numbers to the three dimensional chart. Various tables in the rest of Chapter 2 show how specific diseases are getting much less common, and this militates against the main causal explanation for the declining mortality that Fogel gives as being due to nutrition, as for each disease modern medical procedures are associated with the cure.

Despite this, the ending part of chapter two is a tour de force where he presents his ideas on the Thermodynamic and Physiological factors in economic growth. The gist is that in the bad old days, workers lacked energy to work. When they had more calories due to better seeds and fertilizers, workers were able to work longer and at greater intensity.

Changes in health, in the compositions of diet, and in clothing and shelter can significantly affect efficiency. Reductions in the prevalence of infectious diseases increase the proportion of ingested energy available for work because of savings in the energy required to mobilize the immune system, and because the capacity of the gut to absorb nutrients is improved".

He also believes that Thermodynamic efficiency has increased because we eat more meats and sugars, an increase in the Atwater Factors, to use the language of nutritionists.

After summarizing qualitative factors like this, each one of which is highly controversial, Fogel is given to statements like "The average efficiency of the human engine increased in Britain by 53% between 1790 and 1980", and yet, incentives, incentives, incentives. Without private property, without being able to keep the fruits of your own effort, none of this matters. People who have served as employers and employees know this.

The major contribution of the second chapter is to show that the lower classes gained much more than the upper classes since 1900, but that the upper classes gained more in the time before that:

From the beginning of the Industrial revolution to the end of the nineteenth century, the gap in life expectancy between the upper and lower classes increased by 10 years. But after this, new variables like increased leisure time, the quality of hospitals and public health, more widespread education, and better water supply take effect, and the gains in standards of living and life expectancy are much greater for the poor and the lower classes from this point.

Despite the doubling of the Asian population in just a few decades, advances in seeds, dry farming techniques, improved fertilizer, new crops, and the expansion of arable land have permitted a vast increase in the world's food supply. Not only has agricultural production kept pace with the population explosion for the past half century but the world's per capita production of food has actually increased, rising by about 0.6 % per annum.

A related theme of these chapters is that inequality has been reduced considerably by the fantastic relative improvements in leisure time and life expectancy, and health and ease of living of the lower and middle classes relative to the upper.

The fourth chapter of the book talks about prospects for the future. He forecasts that leisure will increase from today to 2040 from 6 to 7 hours a day and that we will work about 60% as many hours in 2040 as we do today. In the final postscript he forecasts that life expectancy will increase by 2.4 years per decade for women and 2.2 year per decade for me. These equations lead to the prediction that by 2070, female life expectancy will be between 92.5 years, and 101.5 years.

In the society that Fogel sees, leisure activities will be the best to invest in, and durable goods and manufactured goods in general will be stagnating fields. In what I consider the most important investment conclusion of the book he states that:

The point is that leisure care activities, including lifelong learning and health care, are the growth industries of the twenty first century. They will 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 century.

In total, this is a magnificent and thought provoking book. Almost every page gives you a foundation for understanding economic and social trends better. It will get you thinking about the incredible dynamism of the world economy, the resilience and innovativeness of it all, and the diffusion of material goods and improvements in quality of life that it provides. Never again will you believe the agrarian propaganda that the gains of the last century or the most recent decades have been concentrated in the financial sector or the upper classes. Never again will you believe such shibboleths as 'manufacturing is the key to our prosperity' or that the pace of innovation is slower now than before.

This is one book that you will want to read over the dinner table, be sure that is in every library, and that all of your kids and their teachers are exposed to.

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