Good information, but not a great read. Robert Fogel's basic points: Before 1700, nearly everyone was malnourished. Populations were shorter and had lower BMI's as a way to conserve calories. On average, they maxed out at 400-600 spare calories with which to do physical labor to grow food for the future. That's not much, and they couldn't get much physical labor done. We think of earlier ages as doing more work than we did, but it was harder only in the sense that they were tired, diseased, parasite-ridden, and wounded, but had to work anyway. Life expectancy was in the 30's and they seldom lived past 50. A very few wealthy people did better.
From 1700-1900, things were intermittently better for an increasing percentage of people in Western Europe and America, but nowhere else. Even at that, there would be droughts, crop destructions, and other periods of ill-nourishment. Average heights and BMI's started to rise, but irregularly. People were still short, weak, and sick. But enough people had spare calories enough of the year for some really heavy work to start to get done. Combined with new technology, more food could be grown, creating a positive cycle of improvement.
All of this is not very new information, though it has yet to penetrate the popular imagination as much as it should. Fogel's contribution to all this is to insist that it is the consistent nutrition, not improved medical care, that has extended life expectancy. Early or even prenatal "nutritional trauma" is strongly implicated in late-life medical difficulties. Diabetes, respiratory illness, cardiac conditions, genitourinary conditions - all these are cause more by early malnutrition than medical care throughout life. This data has been obscured because most Americans and Western Europeans had mostly adequate early nutrition, while those who didn't also often had poor medical care for years afterward. Modern medicine does a great deal to increase the comfort of life, but the bulk of the life extension from 1900 to the present stems from improved early nutrition and sanitation advances.
Among the more dramatic statistics: Males after age 50 today have on average slightly more than one serious medical condition, such as hypertension, COPD, diabetes. In 1910, males after age 50 had six of these, on average. Those who reached 50 could often expect to reach 63-66, but they were uncomfortable, painful, inactive years.
Fine, then. Good to know. I wish I hadn't had to plow my way through learning about Waaler Surfaces and slight changes in BMI's in Denmark between 1840-1880 in order to get there. After four chapters of this numbing statistical analysis, feeling confident that he has firmly established the point It's the early nutrition, stupid, and not the subsequent medical care that causes low life expectancy and chronic medical problems, Fogel now spreads himself and allows himself to dream what a wonderful world it would be if we focussed more on prenatal and early childhood health.
That's true, I suppose. It would be a wonderful world. And Fogel's got the solution for that 10-20% of American children who get these nutritional traumas, minor by world standards but still significant. Education. Outreach. Free prenatal care. These will banish the later chronic illnesses.
Well, we can hope. There's already a lot of available but unused services for pregnant women, but I grant that even more availability will rescue even more kids. But pregnancy centers all have trouble getting some women to follow through with free services now. It would be a shame for some responsible but poor woman to be unable to get the proper care for her baby, but we are talking about women who are already smoking, drinking heavily, or taking cocaine during pregnancy and nursing. How is education going to change that? They already know it's bad for baby. Outreach. Every welfare office, mental health center, soup kitchen, shelter are plastered with posters about where to get help for a variety of problems.
Provide more services for the youngest, by all means. Outreach like crazy, apply social pressure, and offer rides to the recalcitrant. Save as many as we can. But don't let's kid ourselves that it's a solution.