Bigger and Better?

The Escape from Hunger is an important book by the Nobel economist Robert Fogel. The first three chapters offer a novel, tightly constructed, and convincing argument for a distinctively human form of what Fogel calls “technophysio evolution,” described as “biological but not genetic, rapid, culturally transmitted, and not necessarily stable.” At first blush, biological evolution that is not genetic may sound surprising, but it rests on firm and quantitative evidence, as he explains:

The theory of technophysio evolution rests on the proposition that during the past 300 years, particularly during the past century, human beings have gained an unprecedented degree of control over their environment…. This new degree of control has enabled Homo sapiens to increase its average body size by over 50 percent and its average longevity by more than 100 percent since 1800, and to greatly improve the robustness and capacity of vital organ systems.

The two concluding chapters of the book are also surprising and boldly speculative since Fogel devotes them to an assessment of prospects for further technophysio evolution across the next hundred years, and explores the economic and social implications of making health care “the growth industry of the twenty-first century.”

No one can deny that the human record in the twentieth century was indeed extraordinary. For in spite of all the wars, massacres, and famines that figure in the conventional history of that century, human numbers quadrupled, and most people consumed more and suffered less deprivation than before. This is what Fogel undertakes to demonstrate statistically by applying an economist’s habits of mind to recent biological, physiological, and thermodynamic transformations of the human work engine, our bodies. This ambitious enterprise deserves both admiration and careful scrutiny.

As he tells us in the preface, the first part of this book is “based on the McArthur lectures that I delivered at Cambridge University in November 1996,” adjusted to a more popular audience by omitting some “highly technical” discussion. Behind those lectures stand more than forty years of investigation of changes in patterns of births, marriages, and deaths, drawn largely from English parish records of past centuries, undertaken by Sir Tony Wrigley and his colleagues at Cambridge University, and Fogel’s own thirty years of work, together with a team of assistants, studying changes in adult heights and weights derived mainly from European and American army records dating back to the eighteenth century. Wrigley died before Fogel could deliver the McArthur Lectures at Cambridge, but his junior colleague, Roderick Floud, carries on his work, and the full fruit of these efforts, supplemented by those of various French, Swedish, and Norwegian demographers, is announced in this short book’s bibliography as “Fogel, R.W., Floud, R., and Harris, B. (n.d.), A treatise on technophysio evolution and consumption. In progress.” As his footnotes attest, much crucial data for Fogel’s argument here is borrowed from that prospective work, so that what we have is a condensed, simplified, and preliminary version of the full argument.

Nonetheless, some aspects of the work in hand are beyond me. In particular, in 1982 one of Fogel’s associates at the University of Chicago generated a “three-dimensional diagram, called a ‘Waa- ler surface,'” that “illustrates how height and weight are related to the risk of both poor health and mortality.” Surely, risk of poor health is hard to quantify, yet Fogel clearly sets great store on this diagram. It appears as the frontispiece, is repeated in subsequent pages, and an appendix summarizes its mathematical genesis at the back. I must confess that I found both the language and the equations of this appen-dix largely unintellig-ible. Using data generated by two rounds of “polynomial interpolation” and rejecting results from a further round of inter- polation because of “added computational costs” may be persuasive to statisticians, even if, or especially when, the initial equation includes a factor for “random disturbance.” What makes some data random, pray tell? This mysterious factor, which I think must be arbitrary, perhaps makes every curve satisfactorily smooth. But generating data to make results come out as Fogel wants them strikes me as a dubious exercise of mathematical ingenuity. Consequently, I accepted the Waaler diagrams that appear throughout the first half of the book as an act of faith rather than the self-evident demonstration that Fogel perhaps expected his readers to admire.

Yet mathematical sleight of hand or no, I was thoroughly convinced by Fogel’s argument that chronic undernourishment among European and American populations prevailed in the eighteenth and nineteenth centuries, and presumably also prevailed throughout the rest of the world and across earlier centuries and millennia as well. This seems plausible to me partly because I am just old enough to have experienced dietary deprivation myself. Fresh fruit and vegetables disappeared from my mother’s kitchen in winter, and her nineteenth-century idea that cleanliness was supremely important for health intensified resulting vitamin shortages. For though we ate potatoes almost every day, their skins were thought to be dirty, so we threw away the limited supply of vitamins they contained. Accordingly, by springtime my body was well and truly short of vitamins.

Here is how I responded. When I was six or seven years old, as snow melt bared the ground, our Toronto back yard turned muddy. Cleanliness required me to wear rubbers when playing outside; and to take them off before entering the house again. One day when taking off my rubbers, I dirtied my fingers and sucked them clean, only to discover how delicious the mud tasted. Whereupon I scraped some larger blobs from my rubbers and ate them eagerly. I remember the taste—not sweet, not sour, not much of anything, and unpleasantly gritty though it was—as the most irresistible encounter my tongue ever had; and my subsequent deceit strengthened and confirmed the memory. For when my mother saw me eating mud on the doorstep that first time, she was horrified and strenuously forbade it. But I knew a good thing when I had once tasted it, and for the next few weeks I continued to eat mud from my rubbers surreptitiously until our yard dried out and the mud disappeared.

I now realize that my taste buds were reacting to vitamins in microorganisms that had begun to multiply in the mud. Eating them satisfied a deep-seated bodily craving and surely benefited me. But within a year—probably in 1925—newly discovered vitamins came to my mother’s attention and she started administering bad-tasting cod-liver oil to her children in wintertime, whereupon mud disappeared from my springtime diet.

The memory of this experience predisposes me to accept Fogel’s claim that malnourishment in childhood was once common and can be detected by the way it diminished adult height and weight. His further proposition that food deprivation in infancy reduced longevity and weakened adult resistance to infectious and chronic disease is plausible too, even if his statistical demonstration of that linkage through Waaler surfaces remains inaccessible to my mathematically undernourished mind.

To measure bodily undernourishment, Fogel relies on statistical methods pioneered in France after 1970 that compiled “agricultural accounts.” These, he tells us,

could be converted into estimates of the output of calories and other nutrients available for human consumption through a technique called “National Food Balance Sheets.” Such estimates are currently available for France more or less by decade from 1785 down to the present. In Great Britain, …estimates of the supply of food are now available by half cen-tury from 1700 to 1850 and by decade for much of the twentieth century.

He does not explain how these food balance sheets were compiled and I don’t suppose they can detect vitamin deficiencies of the sort that affected me, but in a rough-and-ready way they allow Fogel to estimate average nationwide access to calories; and calories can then be converted into energy flows within human bodies. Fogel never mentions margins of error, which must be significant for such calculations, perhaps reserving such technicalities for the forthcoming work. Instead he briskly lists some surprising conclusions from his thermodynamic calculations.

First, before about 1890 “even prime-age males had only a meager amount of energy available for work.” The rest went to maintenance of bodily functions—heartbeat, breathing, digestion, etc. Further, “variations in body size were a principal means of adjusting the population to variations in the food supply.” And most surprising of all:

It is worth noting that during the 1880s Americans were slightly shorter than either the English or the Swedes, but a century earlier the Americans had had a height advantage of 5 to 6 cm over both groups. This conflict between vigorous economic growth and very limited improvements or reversals in the nutritional status and health of the majority of the population suggests that the modernization of the nineteenth century was a mixed blessing for those who lived through it.

Fogel’s second chapter, “Why the Twentieth Century Was So Remarkable,” is the core of his book. He deploys Waaler surfaces to demonstrate the relationship between body size and risk of death, and for predicting the onset of chronic diseases. He sums things up as follows:

What is the basis for the predictive capacity of Waaler surfaces and curves?… Research in this area is developing rapidly, and some of the new findings have yet to be confirmed. The exact mechanisms by which malnutrition and trauma in utero or in early childhood are transformed into organ dysfunctions are still unclear. What is agreed upon is that the basic structure of most organs is laid down early, and it is reasonable to infer that poorly developed organs may break down earlier than well-developed ones. The principal evidence so far is statistical and…there is no generally accepted theory of cellular aging.

With this quantitative evidence for increased body size and improved health in hand, Fogel next asks what these physiological changes did to economic productivity. His conclusion is novel indeed:

The available data suggest that the average efficiency of the human engine in Britain increased by about 53 percent between 1790 and 1980. The combined effect of the increase in dietary energy available for work, and of the increased human efficiency in transforming dietary energy into work output, appears to account for about 50 percent of the British economic growth since 1790.

In short, the familiar basis of the Industrial Revolution in Great Britain—the deployment of new machines activated by inanimate forms of energy—was about evenly matched by increases in human capacity for work, thanks to better diet and resulting changes in bodily metabolism, health, and longevity.

Fogel next examines instances in which his new biomedical data conflict with older measures of per capita income and real wages. He concludes that because of “the unmeasured cost of mortality,” which increased as the United States became more urban, “much of what appears to have been a rise in real wages between 1790 and 1860 is spurious.” Similarly, in Great Britain “disparity between the upper and lower classes increased during much if not most of the nineteenth century,” whereas calculations of income distribution indicate no such divergence.

Conflict between biomedical and old-fashioned economic indicators then became spectacularly wide during the 1930s. For example, in the United States GNP plummeted during the Great Depression:

Yet life expectancy between 1929 and 1939 increased by 4 years and the heights of men reaching maturity during this period increased by 1.6 cm.

The resolution of the paradox turns on the huge social investments made between 1870 and the end of World War I, whose payoffs were not counted as part of national income during the 1920s and 1930s even though they produced a large stream of benefits during these decades and continue to do so down to the present. I refer, of course, to the social investment in public health and in biomedical technology whose largest payoffs came well after the investment was made.

The chapter concludes with a discussion of the “remarkable reduction in inequality during the twentieth century” in Britain and America. Fogel summarizes his data as follows:

The twentieth century contrasts sharply with the record of the two preceding centuries. In every measure that we have bearing on the standard of living, such as real income, homelessness, life expectancy, and height, the gains of the lower classes have been far greater than those experienced by the population as a whole, whose overall standard of living has also improved.

He concludes by asserting that

begging and homelessness were reduced to exceedingly low levels, by nineteenth-century standards, only when the bottom fifth of the population acquired enough calories to permit regular work. The principal way in which government policy contributed to that achievement was through its public health programs. By reducing exposure to disease, more of the calories that the poor ingested were made available for work.

Fogel runs out of his stock of biomedical statistics in the next chapter, “Tragedies and Miracles in the Third World.” Instead he uses Food and Agriculture Organization (FAO) data about food consumption and uses his own European and American statistics to draw inferences about what happened elsewhere. He begins, for example, by pointing out that rapid urbanization in Europe and America during the first half of the nineteenth century increased morbidity and mortality until after 1850, when effective systems for water delivery and sewage removal were introduced. This meant that

the West served as an experimental laboratory from which the countries of the Third World could learn when they entered their phase of rapid urbanization. Consequently,…the rapid expansion of cities in the Third World after World War II served to increase longevity

and sustained the spectacular population growth of which we have long been aware.

Increases in food production kept up and Fogel affirms on the basis of FAO statistics that “dietary energy increased by about 400 calories per capita [per day] worldwide between 1965 and 1989,” even though “it remains true that about 15 percent of the world’s population suffers from chronic malnutrition.” Fogel also lacks statistics of body size from the third world, but on the basis of eighteenth- and nineteenth-century figures from France and Great Britain he argues that “the essence of adaptation via body size to an inadequate food supply is a trade-off of current metabolic needs for an increased life-cycle risk of morbidity and mortality.”

The tone of his two concluding chapters, assessing the probable future, remains consistently upbeat:

Since technophysio evolution is still ongoing, it is likely that improvements in health, life expectancy, and average income will also continue…. A century ago, the typical household in OECD nations spent 80 percent of its income on food, clothing, and shelter. Today these commodities account for less than a third of consumption. Many people are alarmed at this…, particularly the reduced role of manufacturing, which they feel may presage economic and social decadence…. A similar state of mind was widespread at the end of the nineteenth century. But then it was the decline of agriculture and the rise of industry that was the focus of concern. Those who identified the good life with agriculture were fearful of life in an urban and industrial age. Now it is life in a service society that promotes anxiety.

Fogel, however, sees only gain in the prospect of shorter hours of what he calls “earn work,” and corresponding increases in leisure, including “voluntary work”:

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.

He then becomes surprisingly utopian when peering ahead:

A half century from now, perhaps even sooner, when increases in productivity make it possible to provide goods in abundance with half the labor required today, the issue of life’s meaning and other matters of self-realization may take up the bulk of discretionary time.

To be sure, “Entirely new educational forms are needed that aim at satisfying not only curiosity, but also a longing for spiritual insights that enhance the meaning of life, and that combine entertainment with edification and sociality.” Is he inviting a crowd of innovative televangelists to cash in? It sounds like it to me.

The estimate that “income expenditures on health care in the United States are likely to rise from a current level of about 14 percent of GDP to about 21 percent of GDP in 2040” does not dismay him, since we can afford it and “expenditures on health care will pull forward a wide array of other industries including manufacturing, education, financial services, communications, and construction.”

Fogel, of course, knows how contentious health care has become, so he devotes his last chapter to “Problems of Equity in Health Care.” His list of desirable reforms much resembles older remedies of the late nineteenth and early twentieth centuries. “The number one priority ought to be an expansion of prenatal and postnatal care targeted particularly at young, single mothers.” Other priorities include “improved health education”; “reintroduction into public schools…of periodic health screening programs”; “the establishment of public health clinics in underserved poor neighborhoods”; and, finally,

a reconsideration of America’s obligation to increase its contribution to the international campaign to bring vaccines and other products to children and adults whose lives can be saved if there is an international will to do so. The lack of access to such products in the poorest 50 or so countries is the most glaring instance of inequality in the global health system and a lingering threat to the health of those in rich countries.

The chapter ends, optimistically as ever:

To poor people, adequate food takes precedence over seeing a doctor. As the people in OECD nations escaped poverty, they demanded more and more health care. The same pattern is now apparent in many Third World countries. The increasing share of global income spent on health care expenditures is not a calamity; it is a sign of the remarkable social and economic progress of our age.

A brief postscript then explores “How Long Can We Live?,” concluding that, in the United States, continuing technophysio evolution may allow female life expectancy to grow at a rate of 2.4 years per decade and male expectancy at a mere 2.2 per decade so that by 2070 American women may live on average to something between 92.5 and 101.5 years. Ouch!

What are we to make of Fogel’s marriage of economics, nutrition, physiology, and prophecy? I will begin with prophecy, for when looking ahead, my views are firm and darkly familiar. Consequently, his rosy vision of what is likely to happen in the twenty-first century seems unlikely to me. Surely warfare and a struggle for security against enemies at home and abroad are far more plausible “growth industries” in the United States than lifelong education and health care; and if they continue to increase, their share of GNP may be expected to reverse the worldwide technophysio evolution that Fogel celebrates. Human societies have often been ravaged and impoverished by war; and mighty governments have sometimes collapsed when violence became unsupportable. Such a future for the United States seems possible, even probable, despite expanding popular demands for health care.

A second source of instability in human affairs is demographic and stems from the breakdown of traditional village communities among the majority of the world’s population. Like the nutritional and physiological changes Fogel describes so convincingly, this change is recent and profound. One result is the decay of long-standing patterns of nurture whereby, as they grew up, youths acquired the full array of adult skills and moral expectations needed to carry on local practices and reproduce their kind, generation after generation. Ever since neolithic times, villages were the places where the very large majority (about 85 percent to 95 percent) of human beings lived and died, and the survival of villages was what allowed cities and states to regenerate after local disasters. That means in turn that recent imperfect absorption of village communities into urban-based social networks puts social and cultural continuity at risk as never before.

For the basic fact is that sanitary and educational reforms of the nineteenth century did not make cities hospitable to child raising; and birth control pills now allow adults to indulge their sexual impulses without giving birth to unwanted children. As a result, in rich, urbanized countries human beings are no longer reproducing themselves. Maintenance of existing cities therefore requires immigration from increasingly distant rural reservoirs. Yet worldwide population growth is fading rapidly as village communities wither, while the ancient bane of urban life, germs that cause infectious diseases, are acquiring resistances to antibiotics that once promised to make infections readily curable. By mid-century, therefore, it seems pretty sure to me that declining populations will prevail worldwide, and the biological and cultural continuity of human societies will come into question as never before.

Deliberate public action almost certainly will alter the course of this prospective demographic collapse; and, to be a bit more cheerful, warfare may also wane among increasingly geriatric urbanized populations. But the impact of such responses remains wholly unforeseeable and so is the future of our general encounter with the organic environment, which sustained the growth of food production since 1700 and permitted Fogel’s technophysio evolution to run its remarkable course. But whether that evolution can continue and usher in the utopian age that Fogel foresees seems improbable to me, since the environment is not infinitely malleable and the prospects for mounting violence in the short run and demographic decay in the slightly longer run seem so great.

None of this undoes what Fogel has to say about the achievements of the twentieth century. By broadening older methods of economic calculus to embrace the changing efficiency of human “work engines” he surely corrects an important aspect of his colleagues’ unconsidered assumption of an unchanging human nature. Since economists first began to construct national accounts to facilitate war mobilization during World War II, they have been intellectual imperialists, displacing sociologists from their previous role as expert policy advisers to the American and many other governments. The Chicago school of economists played a conspicuous part in widening the scope of economic calculation to embrace “human capital” and the like. Fogel continues that tradition by successfully and convincingly annexing changes in human physiology to the economists’ domain by dint of his statistical prowess.

This is a great achievement, and if his calculations are anywhere near accurate, he offers a fundamental new understanding of how the principal social transformations of the past three hundred years became possible. I must reiterate that I do not understand how he manipulated his raw data, so I cannot judge how reliable his results may be. Yet a priori and on the basis of my previous understanding of the facts, I find it hard to believe that half the increase in British economic productivity between 1790 and 1980 can be attributed to better nutrition of the human work force, as he declares on page 39. Inanimate forms of energy drove all the new machines and industrial processes that made mass production of consumer goods possible. Many of those energy sources were brand new, unparalleled before. Was the tapping of such vast stores of inanimate energy really responsible only for half of the result? Maybe so: but I want statistical experts to test his procedures and check his results before I surrender my older ideas about the driving forces of modern development.

A final observation. Fogel’s statistics are drawn from a very limited part of the earth’s population: the United States, Britain, France, Norway, and Sweden, with some attention to the Netherlands. This is an inadequate sample of humankind. Changes in health and nutrition in the rest of the world surely need to be measured in ways Fogel has pioneered before his conclusions can safely be projected worldwide as his chapter on the third world seeks to do. There may even be varying genetic limits on stature (among pygmies, for example) that might affect response to changes in nutrition. Broader samplings of the world’s people and cultures can answer such questions. Pending their results, it seems premature to project Fogel’s optimistic version of technophysio evolution as valid around the globe.