The Escape from Hunger and Premature Death, 1700-2100 by Robert William Fogel

Everyone should have read this in high school. Fogel's economic history of public health provides many useful comparisons for understanding of the privileged and deprived over history. Although his politics occasionally surface (somewhat libertarian), it doesn't kill the book.

the energy value of thetypical diet in France at the start of the eighteenth century was as low as that of Rwanda in 1965, the most malnourished nation for that year in the tables of the World Bank.

-- The Persistence of Misery in Europe and America Before 1900

Among impoverished populations today, work during busy seasons is often sustained by drawing on the body's stores of energy and then replenishing these stores during slack seasons. However, when such transactions are large, they can be a dangerous way of providing the energy needed for work. Although the body has a mechanism that tends to spare the lean mass of vital organs from such energy demands, the mechanism is less than perfect and some of the energy demands are met from vital organs, thus undermining their functioning.

-- The Persistence of Misery in Europe and America Before 1900

Studies of the causes of the reduction in mortality point to the existence of a synergism between technological and physiological improvements that has produced a form of human evolution that is biological (but not genetic), rapid, culturally transmitted, and not necessarily stable...
The theory of technophysio evolution rests on the proposition that during the past 300 years, particularly during the past century, human beings have gained an unprecedented degree of control over their environment -- a degree of control so great that it sets them apart not only from all other species, but also from all previous generations of Homo Sapiens. This new degree of control has enabled Homo Sapiens to increase it average body size by over 50 percent and its average longevity by more than 100 percent since 1800

-- Why the Twentieth Century Was So Remarkable

The analysis in this section points to the misleading nature of the concept of subsistence as Malthus originally used it and it it is still widely used today. Subsistence is not located at the edge of a nutritional cliff, beyond which lies demographic disaster. Rather than one level of subsistence, there are numerous levels at which a population and a food supply can be in equilibrium in the sense that they can be indefinitely sustained. However, some levels will have smaller people and higher normal mortality than others.

-- Why the Twentieth Century Was So Remarkable

The increase in mortality between 1790 and 1860, therefore, indicates that a downward adjustment is necessary even if wage rates in high-disease localities (e.g. cities) fully reflected the extra wage compensation...
They show that much of what appears to have been a rise in real wages between 1790 and 1860 is spurious, and that the pparent growth in average real wagers over these years needs to be reduced by at least 40 percent.

-- Why the Twentieth Century Was So Remarkable

This point is akin to Simon Kuznets's (primary author of the US's GDP statistical accounts) correction of national income fro wages paid to police because crime is not a benefit but a cost of urban production.

-- Why the Twentieth Century Was So Remarkable

Although there were some gains in leisure for the lower class in the United States and Britain during the nineteenth century, they do not appear to have occurred until well past the middle of the century. Of the roughly 25-hour reduction in the work week between 1860 and 1990, perhaps 5 or 6 hours were eliminated before 1890. Moreover, the scope of leisure-time activities was narrow, limited primarily to frequenting bars and attending church. Drama, opera, ballet, concerts, literature, and visual arts were usually too expensive to be readily accessible to the poor. Although there were antecedents during the nineteenth century, public libraries, movies, radio, television, and the like are mainly products of the twentieth century.

-- Why the Twentieth Century Was So Remarkable

If such a computation (correcting income accounts for leisure) was undertaken for each decile of the income distribution, it would be apparent that those in the top decile experienced much less of a gain in leisure, since the highly paid professionals and businessmen who populate the top decile work closer to the nineteenth-century standard of 3,200 hours per year than to the current middle-income standard of about 1,800 hours.

-- Why the Twentieth Century Was So Remarkable

For the cohort born about 1875, there was a gap of 17 years between the average length of life of the British elite and of the population as a whole. There is still a social gap in life expectancies among the British, but today the advantage of the richest classes over the rest of the population is only about 4 years.

-- Why the Twentieth Century Was So Remarkable

to the middle of the nineteenth century, between 10 and 20 percent of the population in Britain and the Continent were homeless persons whom officials classified as vagrants and paupers...
When we speak of homelessness in the United States today, we are talking about rates below 0.4 percent of the population.

-- Why the Twentieth Century Was So Remarkable

A spectre is haunting the OECD nations (ha!). It is not the spectre of poverty or class warfare, as was the case a century ago, when leisure was the privilege of the very rich and workers toiled from sunrise to sunset to earn enough to purchase meagre amounts of food, clothing, and shelter. In 1890, retirement was a rare phenomenon. Virtually all workers died while still in the labor force. Today, half of those in the labor force, supported by generous pensions, retire in their fifties.
To many of today's political leaders this situation, the realization of the dreams of reformers a century ago, is a potential disaster. With the baby-boom generation of 1945-65 now approaching retirement, they are confronted with the choice between defaulting on commitments to retirees, delaying the age of retirement, or increasing the taxes borne by young workers. The spectre that now haunts OECD nations is not class warfare but intergenerational warfare.

-- Prospects for the Twenty-First Century

Of the 24 hours in the day, only 14 hours are discretional, since 10 hours a day are biologically determined by requirements of sleep, eating, and vital hygiene.

-- Prospects for the Twenty-First Century

When the original social security systems were established prior to World War I, they were intended to be class transfers. The levels of transfers wre modest, supplying the elderly with barely enough food to keep them from starving. Such payments were not generally expected to cover the cost of housing or other necessities of life. Moreover, only a small percentage of a cohort was expected to live long enough to become eligible for the beneifits, and the average duration of support was expected to be only a few years. Under these circumstances, a tax of 1 or 2 percent on the income of the richest 5 percent of the population was adequate to fund the program. The rich of Prussia and Great Britain were prepared to bear this cost for the sake of political stability.

-- Prospects for the Twenty-First Century

Entirely new educational forms are needed that aim at satisfying not only curiosity, but also a longing for spiritual insights that enhance the meaning of life, and that combine entertainment with edification and sociality. I believe that the desire to understand ourselves and our environment is one of the fundamental driving forces of humanity, on a par with the most basic material needs. Moreover, as per capita incomes rise and the costs of necessities and consumer durables continue to plunge, individuals and households will spend ever larger shares of their income on services that improve health, enhance knowledge, and are spiritually uplifting.

-- Prospects for the Twenty-First Century

expenditures on persons during their last 2 years of life account for 40 percent of all Medicare expenditures.

-- Prospects for the Twenty-First Century

The supply of chronic conditions that require treatment is much greater at middle and late ages in china than the supply that currently exists in OECD nations. This heavy burden of chronic diseases is due partly to the remarkable rate of incrase in life expectancy since 1950. Life expectancy in China in 1950 was only 41 years at birth, which means that the infant death rate was close to 200 per thousand (!). Such a low life expectancy and such a high infant death rate mean that those who survived to middle ages experienced severe biomedical and socioeconomic insults in utero, in infancy, and in later developmental ages. Despite the rapid advances in public health and strong economic growth, the negative conditions that influenced physiological development remained severe into the early 1960s. As I have already pointed out, such early-life insults reduce the waiting time to the onset of chronic diseases at later ages and increase their severity.

-- Prospects for the Twenty-First Century

Some recent findings suggest that most of the huge increase in life expectancy since 1900 is due to the large investment in public health programs between 1880 and World War II tht cleraned up the water and milk supplies, developed modern waste disposal systems, reduced air pollution, and improved the nutritional status.

-- Problems of Equity in Health Care