Rising Life Expectancy: A Global History (review)

James C.Riley, Distinguished Professor of History at Indiana University (Bloomington), has recast himself as a historical demographer whose body of work incorporates an interdisciplinary approach to the history of morbidity and mortality. His latest work, Rising Life Expectancy:A Global History, focuses on the global democratization of the expectation of long life (p. 221). Riley examines this "health transition" beginning (somewhat arbitrarily) at 1800 and extending to the present day. The global health transition has emerged from the health transitions of individual countries whose pursuit of longer life expectancies have taken divergent paths. Riley identifies six tactical areas for the reduction of mortality: public health, medicine, wealth and income, nutrition, behavior, and education (p. x). Extending life expectancy is a process that incorporates all six of these components to a greater or lesser degree. Rising Life Expectancy devotes a chapter to each tactical area and relates the history of how "each came to be recognized a means of controlling risks to survival" (p. xi). Riley argues that the much studied European and North American process of health transition is only one model among many, and that other nations and regions have been able to accomplish similar results with a differing emphasis on these tactical areas. This recipe for achieving the same relative life expectancy relies on the local character and resources for each region. For example, both Costa Rica and the United States have approximately the same level of life expectancy but have followed different programs (p. xii).

Riley's identification of six components of the health transition efficiently avoids the pitfalls of previous transition researchers who tended to emphasize only one component responsible for the decline of mortality. Rarely do complex phenomena have a single causation. The combination of avoidance and preventative strategies, consciously and unconsciously undertaken, accounts for the health transition, but the relative importance of any one element is impossible to quantify. In addition, the health transition process of England is not the sole program of achieving mortality decline, nor is it necessarily the best for every region. Here, Riley draws with good effect upon his training as a public finance historian in arguing that the western European/North American model—with its numerous and expensive redundancies—is not an effective use of resources in developing nations and is one that needs to be reexamined in the states in which it is currently practiced. This is an important and rarely examined proposition. Programs to decrease mortality in numerous regions have too frequently sought to transplant the processes begun in England in the eighteenth and nineteenth century. The conditions—social, cultural, economic, environmental, and epidemiological, to name a few—of England in the eighteenth century are not comparable to other nations, indeed are not comparable to England today. The leading causes of death in the eighteenth century as identified in the London Bills of Mortality were primarily the result of acute and chronic infectious diseases. In the twentieth century, age and lifestyle diseases (circulatory failure and cancers) are the primary causes of death. This shift of mortality from the very young to the aged has largely accounted for the population explosion of the last two centuries. Rising Life Expectancy is an excellent source book for the latest research on the global health transition (although one wishes for a bibliography as opposed to text citations and suggested readings at the end of each chapter). It also contains a detailed and (after an unscientific random sampling) apparently accurate index.

The book is not without flaws. The graphs and charts are somewhat confusing and not as well integrated into the text as they could be. They also include mistakes and omissions that detract from the book. For example, the text discusses England "standing out" from other nations graphed on per capita gross domestic product and crude death rate, but England does not appear on the...