Rising Life Expectancy: A Global History (review)

The fact that human populations are now living, on average, longer lives than they ever have and that life spans are expected to grow in the future are certainly humanity's crowning achievements of the last two centuries. That the mortality decline has been seen in nearly every human population on earth is remarkable. Riley's book, in providing an introduction to the global history of the mortality decline (which Riley also names the health transition), does not so much detail the trends in rising life expectancy and reduced mortality as it outlines the tactics that have been used to achieve that goal. Riley synthesizes an array of literature to argue that the unique features of mortality reduction have led it to be a global phenomenon. Riley's book makes two arguments—that humans have developed a number of modes of reducing mortality, and that this modal diversity is the reason why rising life expectancy has become a global phenomenon. In Riley's mind, global mortality reduction has become a reality because different populations are able to choose from a fairly large set of tools based on their preferences and tastes for various interventions and policies.

Riley begins in the preface by identifying six "tactical areas" that have been used to reduce mortality: medicine, public health, economic growth, diet, medicine, education, and behavior. His book discusses how each area has come into play since the first declines in mortality were seen in northwestern Europe in the eighteenth century (xi). Notwithstanding the issue of whether six groups is necessary or sufficient, these exact groupings bear little on the larger argument that Riley makes in the book. The introduction begins with a discussion of the historiography of the mortality decline, taking care to note where and how historical demographers, sociologists, epidemiologists, and other social scientists differed in their approaches. Riley then uses the conclusions of that historiography, that there is no one causal link behind the mortality decline, as a framing device to highlight his modal approach to the health transition.

After a chapter that discusses the outlines of the health transition, Riley devotes a chapter to each of the six tactical areas. Within each of these chapters, Riley defines the tactic and describes, in roughly chronological order, how it has been employed in different places and times. The coverage in each chapter is necessarily broad. The public-health chapter, for example, moves from Europeans concerned with filth in the nineteenth century to officials in sub-Saharan Africa battling aids. Riley draws on, and shows a strong command of, literatures from a number of disciplines—from sociology, economics, and anthropology to public health, history, and biological sciences. Although the chapters show areas of overlap, Riley sequences them smartly so that the tactics with the most in common (public health and medicine, diet and income, behavior and education, for example) are placed next to one another to avoid repetition. The advantage of giving each tactic a chapter is that Riley is readily able to give a concise presentation of evidence from a number of sources and disciplines for his argument; the disadvantage is that none of the particulars about the tactical devices is covered in depth, although Riley provides brief bibliographies for further reading at the end of each chapter.

Books that rely heavily on the existing historical literature are necessarily skewed toward Europe, but Riley tries to include all parts of the globe in his discussions. If anything, Riley's use of the literature shows where the gaps remain, and where the need to understand mortality in historical populations, especially those other than Europe, seems most pressing. Research in those areas would allow us to check the veracity of his assumptions.

Riley makes a convincing case for his view of the health transition. This book is a fine example of quality interdisciplinary research designed for a general...