Physiological Consequences of Economic Growth

Physiological consequences of economic growth:

So Big and Healthy Grandpa Wouldn't Even Know You - New York Times: By GINA KOLATA: Valentin Keller enlisted in an all-German unit of the Union Army in Hamilton, Ohio, in 1862. He was 26, a small, slender man, 5 feet 4 inches tall, who had just become a naturalized citizen. He listed his occupation as tailor. A year later, Keller was honorably discharged, sick and broken. He had a lung ailment and was so crippled from arthritis in his hips that he could barely walk. His pension record tells of his suffering. “His rheumatism is so that he is unable to walk without the aid of crutches and then only with great pain,” it says. His lungs and his joints never got better, and Keller never worked again.

He died at age 41 of “dropsy,” which probably meant that he had congestive heart failure, a condition not associated with his time in the Army. His 39-year-old wife, Otilia, died a month before him of what her death certificate said was “exhaustion.”

People of Valentin Keller’s era, like those before and after them, expected to develop chronic diseases by their 40’s or 50’s. Keller’s descendants had lung problems, they had heart problems, they had liver problems. They died in their 50’s or 60’s. Now, though, life has changed. The family’s baby boomers are reaching middle age and beyond and are doing fine. “I feel good,” says Keller’s great-great-great-grandson Craig Keller. At 45, Mr. Keller says he has no health problems, nor does his 45-year-old wife, Sandy. The Keller family illustrates what may prove to be one of the most striking shifts in human existence — a change from small, relatively weak and sickly people to humans who are so big and robust that their ancestors seem almost unrecognizable.

New research from around the world has begun to reveal a picture of humans today that is so different from what it was in the past that scientists say they are startled.... The biggest surprise emerging from the new studies is that many chronic ailments like heart disease, lung disease and arthritis are occurring an average of 10 to 25 years later than they used to.... Human bodies are simply not breaking down the way they did before.... The proposed reasons are as unexpected as the changes themselves. Improved medical care is only part of the explanation; studies suggest that the effects seem to have been set in motion by events early in life, even in the womb, that show up in middle and old age....

In 1900, 13 percent of people who were 65 could expect to see 85. Now, nearly half of 65-year-olds can expect to live that long.... American men, for example, are nearly 3 inches taller than they were 100 years ago and about 50 pounds heavier.... Today’s middle-aged people are the first generation to grow up with childhood vaccines and with antibiotics. Early life for them was much better than it was for their parents, whose early life, in turn, was much better than it was for their parents....

Scientists used to say that the reason people are living so long these days is that medicine is keeping them alive.... But... Fogel... 50,000 Union Army veterans... focused on common diseases that are diagnosed in pretty much the same way now as they were in the last century. So they looked at ailments like arthritis, back pain and various kinds of heart disease that can be detected by listening to the heart.... Fogel and his colleagues looked at health throughout life.... [A]lmost everyone of the Civil War generation was plagued by life-sapping illnesses, suffering for decades.... [T]he Union Army was not very picky. “Incontinence of urine alone is not grounds for dismissal,” said Dora Costa, an M.I.T. economist who works with Dr. Fogel, quoting from the regulations. A man who was blind in his right eye was disqualified from serving because that was his musket eye. But, Dr. Costa said, “blindness in the left eye was O.K.”....

Dr. Almond.... The flu pandemic arrived in the United States in October 1918 and was gone by January 1919, afflicting a third of the pregnant women in the United States. What happened to their children? Dr. Almond asked. He compared two populations: those whose mothers were pregnant during the flu epidemic and those whose mothers were pregnant shortly before or shortly after the epidemic.... [C]hildren of women who were pregnant during the influenza epidemic had more illness, especially diabetes, for which the incidence was 20 percent higher by age 61. They also got less education — they were 15 percent less likely to graduate from high school. The men’s incomes were 5 percent to 7 percent lower, and the families were more likely to receive public assistance.

The effects, Dr. Almond said, occurred in whites and nonwhites, in rich and poor, in men and women. He convinced himself, he said, that there was something to the Barker hypothesis...

Comments

[kharris]

A boat builder I once met took the lines from a Whitehall skiff used in the days of sail around New York harbor. He said that he had left every detail the same, with one exception. Modern bodies could not fit on the seats of the original boats. The needed to be wider, front-to-back, and to be placed higher. In their day, the boats were rowed by full grown men. Today's version was built for a rowing program that caters to children and teens.

[Fergal]

But aren't we playing catch-up, at least partly? Don't we know that the industrial revolution had very damaging effects on people's health, and that the switch from hunter-gatherer to farmer did the same? I thought that was one of Jared Diamond's main points.

From reading this article you'd think height has been increasing monotonically since Adam was a boy (or midget)...

[a different chris]

I'm happy things are much better - I live next to a 19th century family graveyard where children outnumber adults 3:1... but the IR was bad as per Fergal and life in the Civil War Armies was... indescribable.

Of course Keller's wife wasn't lugging a musket around, obviously. But the work level of the time would knock us down, too.

And to me obviously those are the biggest things: technology (both labor-saving and NON-POLLUTING) and more, hell any, free time.

So how does this all square with some Globalization bosters claim that Third Worlders for some reason must live with more pollution and much longer hours for some unspecified period???

[baileyman]

Shouldn't longer lives affect ROI? A person planning for funding a lifetime may look forward to longer years of surplus accumulation and then accept a lower ROI over a longer time in order to fund retirement. If not a person, then perhaps a sociey? In order to run down ROI, does that mean investing more at increasingly lower returns on marginal projects? If investment rises, does nominal GDP growth continue to resemble marginal ROI?

[baileyman]

Shouldn't longer lives affect ROI? A person planning for funding a lifetime may look forward to longer years of surplus accumulation and then accept a lower ROI over a longer time in order to fund retirement. If not a person, then perhaps a sociey? In order to run down ROI, does that mean investing more at increasingly lower returns on marginal projects? If investment rises, does nominal GDP growth continue to resemble marginal ROI?

[baileyman]

Shouldn't longer lives affect ROI? A person planning for funding a lifetime may look forward to longer years of surplus accumulation and then accept a lower ROI over a longer time in order to fund retirement. If not a person, then perhaps a sociey? In order to run down ROI, does that mean investing more at increasingly lower returns on marginal projects? If investment rises, does nominal GDP growth continue to resemble marginal ROI?

[Karlsfini]

Kolata's reasoning is somewhat odd.

The Kellers' ancestors died in their 50's and 60's of cancer; the modern Kellers, however, show no signs of cancer. But wait, the modern Kellers are still in their 40's. Hello?

Kolata also noted (from memory -- I read the article last week) that today only 22% of people between 50 and 65 have joint problems. I'm guessing that means 1% of those 50 and 90% of those 65 have joint problems, so what does the 22% prove? Why lump 50-year-olds with 65-year-olds?

Or better still, why not expand the range to between 40 and 65 and drop the percentage even further?

Very few of us today could endure the normal physical demands of making a living in the 19th century.

I'll go along with us being healthier, fatter, softer, better-fed, longer-lived, but not more "robust."

Admittedly very few people these day "pine away" or die from dropsy, but then none of our unhealthy ancestors a hundred years ago ever contracted lime disease, aids, herpes, ebola, SARS, mad-cow disease, etc.

My first thought after reading the article was where does the NYT find these bozos?

[Robert Waldmann]

I would like to present an alternative hypothesis. The article basically makes a claim of fact -- that people develope Arthritis, heart disease and chronic lung disease at a much older age -- and presents a hypothesis -- that this is due to better health in early childhood, infancy and in the womb. The natural experiement of the Spanish flu provides direct evidence.

The basic reason for the long delayed costs of ill health very early in life (or just before) is that the diseases are not prevented by medical interventions (such as vaccination) and are not believed to have an infectious cause which could be blocked before we know about it by sanitation including water purification, sewage treatment etc. (I really did just delete two ceteras for space)

All very interesting, but I think the diseases in question might have infectious causes so the explanation might be sanitation.

Consider an example: stomach cancer. Over the past century, deaths due to stomach cancer have declined as dramatically as deaths due to lung cancer have increased. This was a mystery until it was discovered that stomach ulcers and stomach cancers are largely caused by helicobacter pilori, an infectious agent. Better sanitation thus explains the decline in stomach cancer (in developed countries).

Rheumatoid arthritis was unknown in the old world before 1492 (they had osteo arthritis but these are different syndromes and the diagnosis can be made from bones). It is very possible that it has an infectious cause brought from the Western hemisphere (syphillis in contrast is definitely an old world disease even if it was introduced to Europe from North Africa about then).

Heart disease can be caused the Streptococcus. More generally, heart disease seems to have something to do with inflamation which might have something to do with an infectious agent.

If the causes are infectious, it is at least possible that the agents will be found implying an even more dramatic improvement in the future.

This is just an effort to provoke thought. I don't really hope to take a heart disease vaccine before I die.

[Robert Waldmann]

I would like to present an alternative hypothesis. The article basically makes a claim of fact -- that people develope Arthritis, heart disease and chronic lung disease at a much older age -- and presents a hypothesis -- that this is due to better health in early childhood, infancy and in the womb. The natural experiement of the Spanish flu provides direct evidence.

The basic reason for the long delayed costs of ill health very early in life (or just before) is that the diseases are not prevented by medical interventions (such as vaccination) and are not believed to have an infectious cause which could be blocked before we know about it by sanitation including water purification, sewage treatment etc. (I really did just delete two ceteras for space)

All very interesting, but I think the diseases in question might have infectious causes so the explanation might be sanitation.

Consider an example: stomach cancer. Over the past century, deaths due to stomach cancer have declined as dramatically as deaths due to lung cancer have increased. This was a mystery until it was discovered that stomach ulcers and stomach cancers are largely caused by helicobacter pilori, an infectious agent. Better sanitation thus explains the decline in stomach cancer (in developed countries).

Rheumatoid arthritis was unknown in the old world before 1492 (they had osteo arthritis but these are different syndromes and the diagnosis can be made from bones). It is very possible that it has an infectious cause brought from the Western hemisphere (syphillis in contrast is definitely an old world disease even if it was introduced to Europe from North Africa about then).

Heart disease can be caused the Streptococcus. More generally, heart disease seems to have something to do with inflamation which might have something to do with an infectious agent.

If the causes are infectious, it is at least possible that the agents will be found implying an even more dramatic improvement in the future.

This is just an effort to provoke thought. I don't really hope to take a heart disease vaccine before I die.

[Robert Waldmann]

I would like to present an alternative hypothesis. The article basically makes a claim of fact -- that people develope Arthritis, heart disease and chronic lung disease at a much older age -- and presents a hypothesis -- that this is due to better health in early childhood, infancy and in the womb. The natural experiement of the Spanish flu provides direct evidence.

The basic reason for the long delayed costs of ill health very early in life (or just before) is that the diseases are not prevented by medical interventions (such as vaccination) and are not believed to have an infectious cause which could be blocked before we know about it by sanitation including water purification, sewage treatment etc. (I really did just delete two ceteras for space)

All very interesting, but I think the diseases in question might have infectious causes so the explanation might be sanitation.

Consider an example: stomach cancer. Over the past century, deaths due to stomach cancer have declined as dramatically as deaths due to lung cancer have increased. This was a mystery until it was discovered that stomach ulcers and stomach cancers are largely caused by helicobacter pilori, an infectious agent. Better sanitation thus explains the decline in stomach cancer (in developed countries).

Rheumatoid arthritis was unknown in the old world before 1492 (they had osteo arthritis but these are different syndromes and the diagnosis can be made from bones). It is very possible that it has an infectious cause brought from the Western hemisphere (syphillis in contrast is definitely an old world disease even if it was introduced to Europe from North Africa about then).

Heart disease can be caused the Streptococcus. More generally, heart disease seems to have something to do with inflamation which might have something to do with an infectious agent.

If the causes are infectious, it is at least possible that the agents will be found implying an even more dramatic improvement in the future.

This is just an effort to provoke thought. I don't really hope to take a heart disease vaccine before I die.

[Robert Waldmann]

Sorry for triple comment. It came back with an error message about how it didn't know what a comment is so I assumed it had not worked.

[andres]

The title of Brad's post is wrongheaded, and once again spotslight the "market-centrism" of the typical economist. Though there is obviously two-way causality, I think that economic growth is more the product of better physical health than the other way around. I would say that the real revolution from the 16th to the 19th centuries (and which is being partially reversed in the 20th and 21st) was the rejection of scriptural authority in favor of experimentation and empiricism, ie science.

Both the industrial and medical revolutions were in fact outgrowths of this fundamental change in thinking. Commerce and markets are a way of distributing many of the products of scientific advancement, but not all of them and not even the most important ones. If left to its own devices, the market would never have introduced universal immunization. The improvements in physical health that Brad talks about are not the products of economic growth but of greater scientific understanding of biology combined with planned government action to make the benefits of this understanding universally available.

[Jim Dandy]

I think Andres is on the right track in emphasizing two-way causality. But one needs to add also the role of the scientific revolution in agriculture.

Initial increases in agricultural productivity in Europe came from organizational changes (enclosure of the common land, crop layout, etc.). But the biggest increases came later with the development and application of science to stock breeding, plant life, food processing, etc., which rested on the emergence and spread of the scientific world view. This agricultural revolution, in turn, supported the growth of urban centers as manufacturing and commercial hubs and sustained the growing and healthy population by making it possible to maintain regularity and expand supply of a wide and increasing range of food products and plant and animal materials.

Of course, to complete the story one would need to recognize the important role of the social revolution involved in the emergence of the capitalist organization and control of productive activity.

[save the rustbelt]

As a side note, two of my great-great grandfathers served in the same Union regiment, and the OVI 68th lost 50 men to combat and 230 men to disease (typhoid and cholera I suspect).

There was a legend in my family that no one had ever died of cancer. Upon some research, it was probably because everyone died of pneumonia or tuberculosis before they had time to die of cancer.

Antibiotics have changed the world forver, for good and bad. My relatives are now living long enough to die of cancer.

[kharris]

Karlsfini,

How do you know few of us could stand the strain of earning a living in an early time? Absent evidence, what is the logic behind the assertion? We are of the same genetic stock. Our contenporaries are able to sleep on sidewalks and eat out of garbage cans without immediately dying. Other of our contemporaries are able to train for and compete in triathlons, which I suspect is as big a strain than was suffered on most of our ancestors. we wouldn't like it. We would not adjust overnight. Couldn't endure it? I'm pretty sure we could.

Andres,

I'm OK with 2-way, but what evidence is there that health has affected output more than the other way around. Technological progress is generally seen as encompassed in economic progress, and that includes labor saving devices, more productive farms, medical advances, more soap and bath tubs. How did better health come about independent of a higher material standard of living?

[Njorl]

The sudden appearance of previously unknown maladies is not necessarily evidence of a direct-cause infectious agent. In fact, there is a scenario that strongly supports the given hypothesis.

The example of rheumatoid arthritis is actually perfect. It was previously unknown in europe, then, became a malady that affected people at a relatively young age. Over time, the average age of onset has increased. Rheumatoid arthritis is an auto-imune disease. The body's own defenses attack the tissues of the joints. It could be that it is a reaction, an indirect result, of some infectious agent. A virus or bacteria could be eliminated by the body's defenses, but the antibodies produced attack the joints for the rest of the person's life. It seems to me that vaccinations and sanitary practices could be causing our immune systems to be less stressed nowadays, making it less likely that they react inappropriately.

I believe there are a number of these diseases in which the body essentially orders its own destruction in a mistaken defensive action. I would be interested to see the statistics regarding the prevalence and age of onset of these diseases.

[Karlsfini]

kharris, right-o. I don't know most of us couldn't endure the physical labor of the 19th cen. There's no way to prove that.

I only doubt we could.

(Remember 60% of us are overweight. Look at any collection of photos from 100 years ago and see how many folks in them seem to need more exercise. When the air-conditioning fails we start dying, although in shorts and t-shirts we're virtually naked compared to the overdressed Victorians.)

I doubt most of us (unless already farming or in the construction business) could endure 10 or 12 hours on an air-conditioned John Deer tractor two days running, much less walk behind a plow and a horse for that long.

Much less man a sailing ship under conditions Dana describes or survive aboard a whaling ship, walk from St.Louis to Oregon territory, ride a horse from Texas to Dodge City -- even without a herd of cattle -- clear a homestead with an ax, dig a mine shaft or the Erie Canal by hand, churn butter and chop wood, haul water,drive spikes through hardwood railroad ties all day, or last very long butchering livestock in Upton Sinclair's Chicago.

We are the same people, just as lab mice are the same as wild mice -- they just can't jump as high or run as fast.

Journals and eye-witness account indicate there was plenty of robustness a hundred years ago.

My point is, we are healthier, but are we really more robust?

[Karlsfini]

Every single commenter above seems to be better informed and clearer thinking than the NYT writer.

Again, where do they find these people?

[Dietrich Kappe]

I used to work for Robert W. Fogel at the University of Chicago. I was charged with developing the software for cleaning the data for the "Early Indicators of Later Work Levels, Disease, and Death" project. The data used a representative subsample (40,000 individuals) of Union Army troops, gathered from service and pension records at the National Archives. (The datasets should be available from the NBER.)

Though I was not involved with the later data analysis, I can say that inspecting the data during the cleaning phase was a shocking experience. Just as an example, having to amputate part of a leg as a consequence of spraining an ankle was not at all uncommon. The little things that could kill you in those days were truly amazing.

I'll leave discussions of causality to other, more qualified people. Let me just say that healthwise, those were not the good old days.

[andres]

"Technological progress is generally seen as encompassed in economic progress, and that includes labor saving devices, more productive farms, medical advances, more soap and bath tubs. How did better health come about independent of a higher material standard of living?"

kharris: Again, I don't have any sources off the top of my head to support this, but a couple of points should be remembered:

(1) the largest component of the decrease in mortality since the 19th century has been from the introduction of vaccination and antibiotics. However, both of these are predominant not because of markets and economic growth, but because of government-mandated distribution and insurance. In several cases where property rights/markets have inhibited the use of such medicines, eg anti-retrovirals, the consequences have been serious.

(2) It is true that the wonders of 21st century medicine often require high technology made possible by electronics, but I would argue that the most world-shaking pre-21st century advances in medicine--immunization, antibiotics, blood transfusions, anesthetics--require relatively little in the way of physical capital and much more in the way of science, experimentation, and research.

(3) the one area where economic growth has made a substantial contribution is in nutrition. However, as the US has shown, free-market agriculture and food products have the potential to create as many negative externalities as positive ones.

(4) Cleanliness is certainly important, but once you go beyond the main social basics--disposal of trash, sewage, and compost, and the sterilization of wounds--the economic as opposed to the aesthetic benefits of cleanliness are vastly exaggerated. A good case can be made that the majority of modern allergies are caused by insufficient exposure to foreign matter, which is directly caused by our clean environment.

All in all, I still think that causality in the past has run more from health to economic growth than the reverse. Some Zarkov bait: Cuba's life expectancy is only slightly lower than in the US in spite of having a much lower per capita GDP level and growth rate. Of course, this causality could change in the future given that the treatment of cancer, autoimmune, and circulatory diseases is going to require sophisticated hardware. But the above is how I see the past.

[anne]

"How did better health come about independent of a higher material standard of living?"

A fine question. Better health is of itself a higher standard of living, but may not be measured so. Chinese health specialists, for instance, long ago understood that simply focusing on infant mortality could make a dramatic difference in longevity. Longevity was raised early on after the revolution by a massive use of para-professional health care workers focusing on infant well-being.

[anne]

I have wondered for a while about the extent to which health care improvements are not easily recorded in an improved standard of living. China improved health care markedly after the revolution, especially so in rural areas, but this was not recorded in standard of living measures. Now, health care has become a problem in rural areas in China in the move to a market economy, and even a health care market, in which better standards of living are readily measured. What then of rural health care?

[anne]

How do we clearly point out that for all the startling gains in the Chinese standard of living these last 25 years, rural health care involving care for hundreds of millions has worsened? The Chinese leadership understands, but the problem is there.

[Anna Haynes]

> "The natural experiment of the Spanish flu..."

I'm not sure how much you can conclude from this one, given that the mortality rate for pregnant women was huge (I think on the order of 50%) - it's possible that the fetuses that survived were not a representative sample.

(i.e. it's interesting and suggestive, but not conclusive)

[JR]

By far the most important event in the improvement of nutritional standards and overall health was Fritz Haber's discovery of a method of nitrogen fixation in 1909. Haber won the Nobel Prize for this work in 1918. It made possible the development of artificial fertilizer (by Carl Bosch at BASF), which ended the Malthusian formula that had condemned all but the rich to lives of border-line starvation for virtually all of human history. The difference between the Kellers of the Civil War era and their modern descendants is not the result of general economic development. Is is the result of a single scientific discovery that changed the way we live more fundamentally than any other development of the twentieth century. See, e.g., Enriching the Earth: Fritz Haber, Carl Bosch, and the Transformation of World Food Production. Vaclav Smil. The MIT Press, 2001.