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Bulletin of the History of Medicine 76.1 (2002) 154-156



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Book Review

Health and Welfare during Industrialization


Richard H. Steckel and Roderick Floud, eds. Health and Welfare during Industrialization. National Bureau of Economic Research Project Report. Chicago: University of Chicago Press, 1997. viii + 459 pp. Tables, figures, map. $80.00 (0-226-77156-3).

This book questions whether the industrial revolution resulted in unmitigated advantage in terms of the quality of life or standard of living, or whether, as "the pessimists" argue, it produced disamenities that (at least for some time) altered standards of living downward. The tentative and qualified answer is that it depends on when industrialization took place: the early industrializing countries, most notably Britain and the United States, suffered early in their revolutions, while countries that industrialized later seem to have gone through the process with more-continuous positive trends. The hope of the editors in raising what is [End Page 154] certainly an old question is that new data will clarify the answer, and the important contribution of the book is its use of new data sources and indicators to examine the question comparatively.

The new data that figure importantly in each of the separate analyses--namely, mortality measures, anthropometric measures, and a combination of indicators, the Human Development Index (HDI)--reflect the view of economic historians that traditional measures of the standard of living (including national income and wealth, per capita income and wealth, per capita consumption, real wages, etc.) fail to account properly for all that is encompassed by notions of well-being and human progress. The addition of mortality rates and other measures of health has taken standard-of-living arguments a giant step forward by asking the question: to what ends can populations put their rising income levels? Or, more precisely, at what unaccounted-for costs to general welfare did incomes rise?

Similar analyses using comparable indicators for Great Britain, the United States, France, Sweden, Japan, Germany, the Netherlands, and Australia constitute the chapters of this book, and the analysis in each chapter is extraordinarily detailed and sophisticated. These economic historians are careful to examine lag times, the relationships between indicators, the use of combined indicators, and cohort effects to illuminate national (and in some cases regional and rural/urban) trends. Each essay makes its own considerable contribution, and the ease of comparison across essays, and hence across nations, produces a whole that is considerably greater than the sum of its individual parts.

There are, however, some difficulties in interpreting the results of these analyses of new indicators, difficulties exemplified by the use of anthropometric measures--especially stature, a key focus of the analytic projects in this book. The examination of stature has become its own minor industry among economic historians and, like the industrial revolution that it proposes to illuminate, this enterprise will no doubt spawn its own debate between optimists and pessimists. How much do data on stature add to our understanding of industrialization's effects on the well-being of populations engaged and/or entrapped in it? Sophia Twarog in her chapter on Germany pinpoints the problems with data on stature: "The very feature that makes stature such a valuable indicator--that it is a net measure of a number of factors contributing to human well-being--also makes it hard to explain what is driving a particular change in stature" (p. 295). Indeed, throughout these essays the reader must adjust and readjust the role that anthropometric data play in the analyses. In the different studies presented, stature is used variably as a measure of, a proxy for, a determinant of, and a consequence of standard of living and health. In the end, often-contradictory findings are open to many interpretations.

The interpretation of the new indicators that is probably most interesting to medical historians and historical demographers is that in a number of countries, including the United States and Britain, the urbanization that accompanied industrialization was the major source of adverse health effects, the concentration of populations in cities having provided the conditions for the spread...

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