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Rising Life Expectancy: A Global History, by James C. Riley. Cambridge, UK: Cambridge University Press, 2001. 256 pages (ISBN: 0521802458). £30.00 (hardcover); £11.95 (softbound).
Between 1800 and 2000, life expectancy at birth rose from about 30 years to a global average of 67 years, and to more than 75 years in favored countries. This dramatic change, called the health transition, fundamentally altered patterns of human survivorship and cause of death. During this transition, the predominant causes of death have shifted from infectious diseases with a short course, to chronic diseases, often with a protracted course. The ranks of people living in their most economically productive years has increased, and the old have become more commonplace everywhere. This increase in life expectancy has allowed humankind to benefit from the experience and productivity of individuals who survive to guide their children and grandchildren, who can achieve a mature sense of themselves, and who have the confidence and productivity that comes from the expectation of a long life. On the other hand, increases in life expectancy have not been universal, and the changing regime of diseases has also meant that the number of years that individuals may spend in sickness has yet to decline in much of the world.
Rising Life Expectancy: A Global History examines six major strategies by which humans have reduced risks to their survival to promote population growth and aging. These strategies include Public Health, Medicine, Wealth and Economic Development, Nutrition, Household and Individual Health Behaviors, and Literacy/Education. While much of the historical evidence marshaled in this book is, by necessity, drawn from the more affluent countries where the health transition began (e.g., England, Sweden, Japan), Riley compares and contrasts this evidence with what has occurred elsewhere in the world. Indeed, the comparative approach serves to identify the relative effectiveness and importance of these six strategies in different environments and at different points in the health transition. The author concludes that the current crude death rate of 8.5/1000 is amazingly low considering that only 200 years ago the rate was roughly four times that high. At the same time, he emphasizes that poor nations and other disadvantaged subpopulations have not fully shared in this human achievement, despite our theoretical ability to prevent and/or treat diseases that reduce life expectancy, such as tuberculosis, measles, malaria, and acquired immunodeficiency syndrome (AIDS).
For the reader who is unfamiliar with the literature on the health and epidemiological transition, the first chapters provide an introduction and overview to the topic that essentially summarize previous literature. General observations about the health transition, for example, that an increase in total life expectancy is not necessarily accompanied by an increase in years of healthy life, are useful concepts from the overview to which the author refers in later chapters. Each subsequent [End Page 135] chapter summarizes a broad sweep of historical evidence as it pertains to six somewhat interdependent "tactics" of health transition. In particular, the discussion of "filth theory" and the "sanitary revolution" of the mid-19th century is excellent, and impressively synthesizes the changing patterns of human settlement with increasing industrialization and urbanization, social theories castigating disease as a product of poverty, and the history of vaccination development and clean water systems.
Similarly, the book provides insights into why the biomedical approach to infectious disease control had immediate success in the developing world in the 1950s and 1960s, but has subsequently reached a ceiling of effectiveness. In the West, hundreds of years of evolving notions of health and disease, informed by filth and germ theories, the consolidation and professionalization of medical practice, and the practice of inoculation, resulted in declines in mortality before biomedicine (antibiotics, mass immunizations) ever arose as a survival strategy. By contrast, in countries that have only recently begun the health transition, biomedicine has been the first and primary strategy used. As this large "experiment" in human survival has shown, without the critical groundwork of clean water systems, the cultural acceptance of the idea that infectious diseases are caused by...