The Escape from Hunger and Premature Death, 1700-2100 (review)

A review of the most recent book by the 1993 Economics Nobel Prize winner Robert Fogel has to start with the man himself. Fogel has completed now more than four decades of distinguished research on the intersection of history, economics, demography, and public health. His earlier contributions focused mostly on American economic history and more specifically on the history of slavery. As in this book, Fogel's research is data-based and typically involves meticulous construction of large and complicated datasets that enable him to answer previously unanswerable questions.

An important dataset that Fogel was instrumental in constructing, and which is utilized at length in this book, is a longitudinal dataset based on the pension records of the Union Army from the second half of the nineteenth century that contains medical histories of veterans from childhood until death. This dataset, and similar ones constructed by others for French, English, and Norwegian data, are the cornerstone of The Escape from Hunger and Premature Death, 1700–2100.

The central theme of this short manuscript (111 pages of text and 80 pages of bibliographical and other notes) is what Fogel terms the "technophysio evolution"—a process that describes the dynamic links between health, longevity, and productivity of humans in the last three hundred years. The first and most significant part of the book (chapters 1–2) describes the synergies between the technological developments in production and health throughout the human life span. As is typical for this data-centered work, the main research question is made clear in Table 1.1 (p. 2), in which we observe continuously increasing life expectancy (at birth) in, for example, England from thirty-two in 1725 to forty-eight in 1900 and seventy-six in 1990 with by far the most significant increase occurring between 1900 and 1920. After describing the history of medical and other research on this trend, Fogel suggests that "technophysio evolution" is the appropriate descriptor for this historical process.

To a reader unversed in the research in this area, like this reviewer, the most surprising and intriguing argument raised is the interactions between caloric intake, productivity, and longevity. "The condition for a population to be in equilibrium with its food supply at a given level of consumption is that the labor input (measured in calories of work) is large enough to produce the requisite amount of food" (p. 16). This dependence on caloric intake for productive capacity (in agriculture) and the consequent effect of this productivity on the future caloric intake will create cycles that will result in periods of increased productivity, longevity, and increases in physical stature but will also occasionally result in declines of all three—declines that are well documented. The process will depend not only on technological advances but on other aspects that might lead to changes in the efficiency in which humans convert energy input into work output of energy (calories). Thus, this recent evolutionary techno-physiological process is very much biological but is not genetically driven, inevitable, nor, for that matter, stable.

In the only technically challenging part of this book, Fogel goes on to describe the historical evolution of mortality risk and its dependence of height and weight using a diagrammatic tool called a Waaler surface. As W. H. McNeill, reviewing the book for the NY Review of Books, observed, it is possible to read and understand all the major arguments and ideas in this work without recourse to these complicated mathematical representations.

Fogel goes on to argue that the "twentieth century . . . 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" (p. 39). In a typical application of his theory, for example, he argues that "Begging and homelessness were reduced to...