Rising Life Expectancy: A Global History (review)

This book assumes that all human kind “want to live a long life” and that “society benefits from the experience and wisdom of older people”.[p. 220] Yet as Jonathan Swift pointed out some time ago (Gulliver’s Travels: 1726), these assumptions are somewhat problematic. Also problematic is Riley’s frequent use of the nineteenth century British imperialist term, “traditional” when refering to any and all curative practices—past and present—which are not approved by the present-day western medical establishment.

Yet Riley is quite correct in assuming that in the years since c. 1910, among the fifteen percent of the world’s population who live in the West and are not members of marginalized social groupings, life expectancy has risen dramatically. In these privileged regions (North America, West Europe, Australia and Japan), by the end of the twentieth century the majority of women could expect to live into their mid-eighties and the majority of men into their late seventies. And in a few selected corners of the non-West such as Costa Rica, Cuba and Kerala State in India, the percentage of people over the age of sixty actually found in regional communities was beginning to resemble the situation found in the West.

Riley holds that those societies in which longevity has become the norm have passed through “the health transition”. Yet he is well aware that health transitions are in fact multi-faceted. Techniques and mind-sets which led the way in one society at one particular period (for example, sanitary “science” in England after 1830 and the germ theory in the German lands after the mid 1860s) succeeded in cutting down mortality rates from certain infectious diseases: this improvement was reflected in official statistics.

Yet before life-expectancies at birth could break through the barriers which prevented them from going much beyond the age of 45 or 50 (where they were at around 1910), other technologies and mind-sets also had to be brought to bear. Many of these new techniques had wonderfully benign effects on new-born infants and young children, leading to massive reductions in infant mortality. With the dropping away of infant death rates from more than 100–200 per 1000 to 10–15 per 1000, life-expectation at birth (as statistical artifact) obviously shot forward. With this, the beneficiaries—the world’s economically and politically dominant groupings—had indeed entered a new era, unprecedented in human history.

In dealing with these multi-faceted regional and super-regional health transitions, in six separate chapters Riley discusses the contributions of, and limitations of, public health authorities, medical authorites, economic development, household management, diet, and education. Some of the information he provides us in these chapters is useful, relevant and even insightful.

But when looked at from the perspective of a social historian, and from the perspective of the non-West where 85% of the world’s population live, Riley’s “global perspective” can more acurately be described as a view of the world through rose-tinted glasses worn in the leafy suburbs of a quiet Midwestern university town. In this “global history” Riley shows precious little awareness of power relationships between dominant groupings in any society and the subjugated many. No one reading this book, for example, would fully realize that the health history of African Americans in general and their recent slave ancestors (12–15% of the total US population) was and is quite different from the health history of Euro-Americans.

Looking beyond the shores of North America, it is apparent that Riley has no awareness of the real meaning of imperial hegemony in times past. Dependent on smoothly written secondary sources, he boldly states, for instance, that new-style western medicine was rejected by the tradition-bound people of India in and after the mid-nineteenth century. [p.90] He is unaware that after mid-1868, the high command structure of western medicine in India strictly forbad its doctors to apply the insights being used with such...