The Changing Body: Health, Nutrition, and Human Development in the Western World since 1700, Roderick Floud, Robert W. Fogel, Bernard Harris and Sok Chul Hong, Cambridge University Press, 456pp, £19.99 (paperback)
A YouTube video called ‘The Joy of Stats’ is doing the rounds. It features Hans Rosling, a livewire Swedish professor of International Health. In just five minutes he conveys, with the aid of vivid graphical representation, the dramatic increase that has occurred in human life expectancy over the past two hundred years.
In 1800 no country had an average age above forty; yet by the early twenty-first century citizens of most developed countries can expect to reach eighty and beyond. Many developing countries, especially those outside Africa, are converging with Western levels.
Rosling concludes with bullish optimism: ‘I see a clear trend into the future with aid, trade, green technology and peace it’s fully possible that everyone can make it to the healthy wealthy corner.’
Explanations for this seismic leap, which has brought global population from about one billion in 1800 to seven billion today, are offered in a recent publication: The Changing Body: Health, Nutrition and Human Development in the Western World since 1700. Written by four academics from a range of fields, it applies a scientific rigour that is rarely encountered in historical work. The distinct educational tracks laid for science and humanities from a young age in this country usually militate against such joined-up thinking. Historians do not understand science, and scientistsdo not get history. Fortunately the twain meet in this work which offers a treasure trove for future scholars.
The authors’ assessment accords with Rosling’s: ‘The process of industrialisation that began in Western Europe in the eighteenth century has allowed human beings to reach further towards the achievement of the potential which resides in every human being’; ‘We are taller, heavier, healthier, and longer-lived than our ancestors; our bodies are sturdier, less susceptible to disease in early life and slower to wear out’.
They assert: ‘there is every reason to expect that average life expectancy will continue to increase for many years to come, with profound implications for current assumptions about the limits to human longevity’. It seems likely that we will be living longer than our parents. This has profound implications for governments and for individuals. How did we get to this point? And, should we be quite so optimistic about the future?
The authors’ essential thesis is that ‘the health and nutrition of one generation contributes, through mothers and through infant and childhood experience, to the strength, health and longevity of the next generation’.
The ‘primary evidence of nutritional status lies in our bodies and in particular our height and weight’. They cite a study by Waaler  which shows that shorter men and women are more likely to die at younger ages than taller men and women. It would seem that as we grow taller we live longer too.
The important developmental stages are in utero, early infancy and adolescence. Inadequate nutrition at those stages stunts normal growth and brings long-term health sequelae. The Barker hypothesis posits that poor nutrition of a foetus predisposes that person to develop diseases in adulthood.
Moreover, the authors argue it is in ‘no way fanciful to see the influence of the health and welfare of grandparents in the bodies of their grandchildren and the effect may be even longer-lasting’. A woman inadequately nourished in childhood has a reduced reproductive capacity. Her own diet may have improved but the legacy of poor nutrition and attendant disease will stunt the development of her offspring in utero. That offspring’s offspring will also be affected, though less so as nutrition levels improve and health problems diminish. Thus, it has taken a number of generations for Italian- and Japanese-Americans to converge with the height of their fellow Americans.
Strong Argument for the State
In recent times there has emerged an increasing clamour against state interference in the economy coupled with restored faith in an Invisible Hand, the self-regulating nature of the marketplace. One such Free Market- enthusiast is Niall Ferguson who attacks the levying of taxation in his new book Civilisation: ‘Private property rights,’ he says, ‘are repeatedly violated by governments that seem to have an insatiable appetite for taxing our incomes and our wealth and wasting a large proportion of the proceeds.’
Libertarianism might emerge as a popular political movement in the twenty-first century and not only in the US where Ron Paul is making waves. But The Changing Body provides an irresistible argument in favour of state intervention in the economy.
From the beginning of the seventeenth century there was a surplus of grain in England as agricultural capacity exceeded the requirements of the population. Carryover inventories of food averaged between thirty-three and forty-two percent of annual consumption. As a result in that period: ‘famines were man-made rather than natural disasters’. The typical English subsistence crisis after the ascendancy of Henry VIII did not take place because of insufficiency but because ‘the demand for inventories pushed prices so high that labourers lacked the cash to purchase grain’.
During the late Tudor period ‘paternalistic’ authorities recognised this, acquired grain surpluses and sold it on at prices affordable to the lower echelons of society, much to the annoyance of merchants, brewers and bakers. That system unravelled during the Civil War of the 1640s when Roundhead mercantile interests began to exert authority over government decision-making. It was only in the 1750s, in the wake of food riots of
‘unprecedented scope’, that the state began to subsidise grain once again. As a result, by the early nineteenth century, famines had been conquered in England ‘not because the weather had shifted, or because of improvements in technology, but because government policy … had unalterably shifted’.
That beneficence did not, however, extend to Ireland in the late 1840s when the potato blight phytophthora infestans struck what was nominally a part of the United Kingdom since the Act of Union of 1801. Here the Invisible Hand wrought hunger, pestilence and emigration that reduced the population by two million. An independent state dedicated, presumably, to the welfare of its citizens would have sought to mitigate its effects but for Charles Trevelyan, who was invested with responsibility for directing relief, the famine was ‘a direct stroke of an all-wise and all-merciful Providence’.
In order to maintain a consistent food supply and to put a stop to environmentally egregious practices national and supra-national interference is necessary. The natural environment, especially the soil, is a country’s most important resource. Only governments have the wherewithal, democratic legitimacy and range of expertise to negotiate a path away from the present fossil fuel-reliance of farming. Although the authors of The Changing Body devote considerable attention to agriculture they fail to highlight that the dramatically increased productivity which facilitated population growth in the first place is utterly dependent on oil and natural gas. The recent BBC documentary, ‘A Farm for the Future’ (available on YouTube), analyses the issue and shows some of the innovative new approaches emerging, such as permacultures and forest gardens.
Increased life expectancy did not coincide with the Industrial Revolution. The first four decades ‘did little to change either the proportion of the English ultra-poor or the level of their real earnings’. Indeed, most commentators agree that there was even a decline in the important indicator of average heights of both men and women between circa 1820 and 1850.
The slums of the early nineteenth century were breeding grounds for disease. Governments did little to improve the workers’ lot beyond maintaining a secure food supply. Moreover, nutritionally-empty sugar became a working class staple, a point that is not analysed by the authors. Significant discussion of nutritional quality as opposed to nutritional quantity (measured in terms of calories) is absent from this book. There is no mention of the development of the nutritionally-ruinous Chorleywood Bread Process in 1961, which allows for super-quick fermentation and has given bread a bad name, and the invention of high fructose corn syrup in Japan in 1967, which has been described as ‘revenge for Hiroshima’. Both have caused regressions in human health in the Western world and are causes of obesity. A wider discussion of the declining nutritional value of many common foodstuffs that has occurred in recent times is called for, including the deleterious effect of the pesticides and synthetic fertilisers used in agriculture.
The authors assert: ‘it was only between 1870 and 1913 that the standard of living in the industrialised world rose noticeably above early modern levels’. This was the legacy of government interference in many countries. Germany led the way with the introduction of Health Insurance in the 1880s.
A crucial breakthrough came with the availability of clean drinking water at the end of the nineteenth century. An important consequence of early nineteenth-century urbanisation had been ‘the deterioration of the quality and quantity of the water supply’. Drinking water only improved after substantial state-funded infrastructural investment in the 1890s. Thereafter a range of water-borne diseases like diarrhoea, cholera and dysentery ceased to trouble the population to anywhere near the same extent.
Clean water and a steady food supply improved child health, thereby allowing adults to live longer and enjoy enhanced reproductive capacity. Improvements in diet and public housing after World War I, in England at least, increased life expectancy further. The technological advances of the Industrial Revolution were being deployed for the benefit of the entire population. The Invisible Hand was being kept in the pocket.
The authors make a claim with substantial implications. They say: ‘it would be easy to exaggerate the importance of scientific medicine when one considers that much of the decline in the mortality associated with infectious diseases predated the introduction of effective medical measures to deal with it.’ Until about fifty years ago those infectious disease were the main cause of mortality in the Western world.
They acknowledge that drugs like insulin, penicillin and prontosil, as well as the mass immunisations of the post-Second World War era, made some difference but the authors conclude that the availability of sufficient food and clean water were the main determinants of overcoming those diseases. The main causes of mortality today are, of course, heart disease and cancer. The key to overcoming them is also strongly linked to nutritional inputs. Unfortunately, the Western approach to medicine has long been pathology-led rather than preventative. Doctors ‘fix’ illnesses in discreet parts of the body, including diseases of the mind, by administering pills that provide the patient with a sense of security. That reassurance might well be more important than the drug itself, as shown by the placebo effect. Perhaps we really have nothing to fear except fear itself.
Cancer and heart disease are pathologies strongly linked to lifestyle choices, especially emanating from the foods and drinks we ingest and a lack of physical exercise. The Department of Health (or should we say the Department of Disease? The War Office went the other way by changing its name to the Ministry of Defence despite an undimmed enthusiasm for waging wars) has been conspicuous in its failure effectively to communicate a coherent health message since the 1970s when obesity began to replace tobacco as the most significant threat to long-life and well-being.
The population may be growing older but ‘it has been claimed that the majority of the years which have been added to life are years of disability’. Lifetimes of poor quality diet and a lack of physical activity are putting huge pressure on the national exchequer. Many seem resigned to an old age of stasis, atrophy and expensive medical treatments.
It seems that the present approach to Medicine is not fit for purpose. Doctors are considered experts in human health yet their life expectancy is not noticeably higher than the population at large when adjusted for social class. The model of Eastern medicine is different. It emphasises health, especially through nutritional inputs, rather than addressing symptoms.
Rather than prescribing pills willy-nilly, doctors should be advocating the consumption of different foods for medicinal purposes and strenuous outdoor exercise, as well as learning about ‘unscientific’ but effective treatments like shiatsu, homeopathy and acupuncture. The nature of medical studies should change. Positive aspects of Western medicine, particularly in the area of surgery in which remarkable advances have occurred, should be retained but the emphasis on pills for every conceivable condition should be revealed as a conspiracy on the part of the pharmaceutical industry. Overall, health, rather than disease, should become a doctor’s expertise.
More generally, initiatives to address the terrible food sold in many dominant food businesses are required. Just as merchants between 1640 and 1750 held back improvements in health, similarly today the merchant- owners of supermarkets and fast food chains participate in bringing premature death and poor quality of life through promotion and supply of unhealthy food. Governments should not refrain from interfering, and perhaps anticipate a reaction every bit as belligerent as that which emanated from the Roundheads. This is not a call for a Communist chain of supply but rather for a break-up of monopolies and a tempering of the market. It is hard to see how the model of the supermarkets is part of the solution.
The unprecedented age which many of us are going to reach if the authors’ predictions are proved correct requires we maintain good health from a young age. Preparation of healthy food and the cultivation of crops should be integrated into the educational system. Planning for the future should mean events fifty years hence rather than the life of a government.
The message also needs to be broadcast that consumption of meat at current levels is unhealthy and environmentally irresponsible, and that refined sugars are a slow-acting poison. (Perhaps people need to look at units of sugar in the same way as units of alcohol.)
Getting the Message Across
Nutritional status is intimately tied to social class. The authors observe how, in response to nutritional prompting by the state, ‘people in the “higher” social classes are more likely to eat healthy foods and engage in voluntary physical activity, and less likely to smoke’.
The authors identify a worrying trend whereby government health policy actually ‘tends to exacerbate health differences’: higher social classes take on board health advice, rather than the poor for whom the need is most pressing. The level of income disparity in a society is reflected in nutritional status. Inequality breeds obesity.
Extreme income variation compounds underlying poverty by bringing psychosocial stresses that deter people from improving their lifestyles. A person living in dire, crime-bedevilled accommodation amidst a rampantly materialistic society will draw reassurance from food and a fag rather than listen to what their social betters urge them to do. It is no coincidence that European countries with less social inequality are also less prone to obesity.