the changing body health, nutrition and human development in the western world since 1700 bernard...
TRANSCRIPT
The changing body
Health, nutrition and human development in the
western world since 1700
Bernard Harris30 June 2011
Caption for the image should be placed in a clear area on the image to ensure it is legible
3
Introduction• How has human health changed in the western
world since circa 1700?
• Why has it changed?
• What are the consequences of these changes?
4
Measuring changes in human health:the importance of height
• ‘A child’s growth rate reflects, perhaps better than any other single index, his [sic.] state of health and nutrition; and often indeed his psychological situation also. Similarly, the average values of children’s heights and weights reflect accurately the state of a nation’s public health and the average nutritional status of its citizens, when appropriate allowance is made for differences, if any, in genetic potential…. A well-designed growth study is a powerful tool with which to monitor the health of a population, or to pinpoint subgroups of a population whose share in economic and social benefits is less than it might be. Indeed, as infant mortality rate goes down during a country’s development, so the importance of monitoring growth rate increases’ (P.B. Eveleth and J.M. Tanner, Worldwide variation in human growth, Cambridge: CUP, 1990, p. 1).
5
Technophysio evolution• ‘The theory of technophysio evolution rests on the
proposition that, during the last three hundred years, particularly during the last century, humans 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’ (R. Fogel and D. Costa, ‘A theory of technophysio evolution, with some implications for forecasting population, health care costs and pension costs’, Demography, 34 (1997), 49-66 (at p. 49)).
6
Anthropometric history• The conscripts of 1868 (Le Roy Ladurie et al., 1968,
1971, 1979)
• The economics of mortality in North America, 1650-1910 (Fogel et al., 1978, 1982)
• Height and the standard of living (Floud 1984; Steckel 1992)
7
Changes in stature in Britain:Adults
Source: R. Floud, K. Wachter and A. Gregory, Height, health and history, Cambridge: CUP, 2011, p. 154.
8
Changes in stature in Britain:Children
Source: R. Floud, K. Wachter and A. Gregory, Height, health and history, Cambridge: CUP, 2011, p. 166.
9
Changes in stature in Britainin international context (Mature height, in cm)
Denmark
France Great Britain
Hungary Norway Sweden
18-III - - 165.5 167.4 165.6 168.118-IV 165.7 163.0 168.6 166.6 165.5 166.719-I 166.2 163.7 167.9 163.1 166.6 166.719-II 166.7 164.3 171.2 163.5 167.4 167.319-III 165.3 164.7 167.2 162.3 168.7 168.019-IV 167.8 165.4 168.0 163.8 169.6 169.520-I 169.3 166.3 168.2 165.4 171.0 171.920-II 171.5 168.0 170.0 168.4 173.8 173.920-III 175.5 171.2 175.0 170.7 177.6 177.220-IV 183.2 174.7 176.6 - 179.5 179.2
10
Life expectancy
Life expectancy at birth in selected European countries, 1850-2009
0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00
Denmark
England & Wales
France
Iceland
Netherlands
Norway
Sweden
Life expectancy (years)
1850-1859 1900-1909 1950-1959 2000-2009
Notes: The most recent figures for Iceland and the Netherlands refer to the period 2000-08 rather than 2000-09.Source: http://www.mortality.org/ (accessed 7/6/11)
11
Real wages
Figure 4.6. Real wages (1770/2-1848/52)
60.00
70.00
80.00
90.00
100.00
110.00
120.00
130.00
140.00
150.00
1770-1772
1773-1777
1778-1782
1783-1787
1788-1792
1793-1797
1798-1802
1803-1807
1808-1812
1813-1817
1818-1822
1823-1827
1828-1832
1833-1837
1838-1842
1843-1847
1848-1852
year
rea
l w
ag
es (
17
78
/82
=1
00
)
Phelps Brown & Hopkins Feinstein (original series) Feinstein (adjusted series)
Notes. The data for ‘Feinstein (original series)’ are his estimates for real earnings adjusted for unemployment in Great Britain. These figures have been modified in the light of Allen’s revised consumer price index to produce the estimates in ‘Feinstein (adjusted series)’.Sources: Wrigley and Schofield 1981: 642-4; Feinstein 1998: 648, 652-3; Allen 2007: 36.
12
Food availability• Domestically-produced cereals and pulses
• + other domestically-produced foodstuffs
• + imported foodstuffs
13
Domestic production of cereals and pulses
• Land under cultivation (1700, 1750, 1800, 1850)
• Yield per crop per acre
• Amount available for human consumption
– Total – (seed + animal feed + milling + distribution)
• Energy values
14
Calories from domestically-produced cereals and pulses
Allen 1994 Turner, Beckett and Afton 2001
1700 1750 1800 1850 1700 1750 1800 1850
Wheat 502 430 732 706 502 526 717 729
Rye 251 131 76 14 251 131 69 14
Barley 598 421 315 227 598 418 307 227
Oats 122 205 172 101 122 269 184 120
Beans and peas 93 88 71 33 93 68 56 32
Total 1,566 1,275 1,366 1,082 1,566 1,412 1,333 1,122
Notes: We have used Allen’s estimates for rye to fill the gap in Turner, Beckett and Afton’s in 1750.
Sources: See Tables A2 and A3.
15
Other domestically-produced foods
Foodstuff Source of data
Mutton, lamb, beef, veal, pork, ham King (1696); Holderness (1989)
Bacon, lard and pork Estimated from US figures for the late-1870s (Bennett & Pierce 1961)
Cheese, butter and milk 1750, 1800 & 1850 data from Holderness (1989); 1700 figures extrapolated from the later data
Fish, garden vegetables, fruit and nuts Derived from the Royal Society’s figures for 1909-13 (PP 1917)
Potatoes Calculated from Salaman (1949)
16
Calories from other domestically-produced foodstuffs
Source of kcal 1700 1750 1800 1850 1909-13
Cereals and pulses (1A) 1,566 1,275 1,366 1,082 217
Cereals and pulses (1B) 1,566 1,412 1,333 1,122 217
Meat & lard (2) 307 507 456 348 325
Dairy (3) 231 279 236 219 286
Fish (4) 24 24 24 24 24
Garden (5) 12 12 12 12 12
Fruits & nuts (6) 10 10 10 10 10
Potatoes (7) 53 79 154 255 196
Cottage produce (8) - - - - 135
Farm produce (9) - - - - 26
Poultry, game and rabbits (10) - - - - 28
Total (11A) 2,202 2,185 2,257 1,949 1,259
Total (11B) 2,202 2,323 2,224 1,990 1,259
17
Imports and exports
Cereals 1700, 1750 & 1800: Mitchell (1988); 1850: Annual accounts
Meat Mitchell (1988)
Dairy products 1800: John (1989); 1850: Annual accounts
Sugar 1700 & 1750: Sheridan 1973; 1800 & 1850: Mokyr 1988
Wine and spirits 1700, 1750 & 1800: Schumpeter (1960); 1850: Annual Accounts
Fish Royal Society (1917)
18
Calories from imported foodstuffs
Source of kcal 1700 1750 1800 1850 1909-13
Cereals and pulses (1) -13 -168 86 367 788
Meat (2) 12 262
Dairy (3) 16 20 166
Fish (4) 8
Garden (5) 31
Fruit and nuts (6) 9 55
Potatoes (7) 13
Sugar (8) 28 72 95 136 395
Wine & spirits (9) 12 11 17 12
Total (10) 26 -85 215 555 1,718
19
Total food supply
Table 4.9. Average number of calories available for consumption per capita per day in England and Wales 1700-1909/13.
Source of kcal 1700 1750 1800 1850 1909-13
Domestically-produced foods (A) 2,202 2,185 2,257 1,949 1,259
Domestically-produced foods (B) 2,202 2,323 2,224 1,990 1,259
Imported foods 26 -85 215 555 1,718
Grand total (A) 2,229 2,100 2,472 2,504 2,977
Grand total (B) 2,229 2,237 2,439 2,544 2,977
Notes: A: Based on crop-yields estimated by Chartres (1985), Holderness (1989) and Allen (1994); B: Based on crop-yields estimated by Turner, Beckett and Afton (2001).
Sources: See Tables 4.7 and 4.8.
20
Composition of diet
A. Crop yields from Chartres. Holderness and Allen
Calories %
Source of kcal 1700 1750 1800 1850 1909-13 1700 1750 1800 1850 1909-13
Cereals 1,461 1,019 1,382 1,396 999 65.54 48.51 55.88 55.74 33.55
Fish 24 24 24 24 32 1.07 1.13 0.96 0.95 1.08
Fruit and vegetables 167 189 247 338 476 7.50 8.98 9.97 13.50 15.98
Meat and dairy products 538 786 708 599 1,075 24.13 37.42 28.63 23.92 36.12
Other 39 83 113 147 395 1.77 3.95 4.56 5.89 13.27
Total 2,229 2,100 2,472 2,504 2,977 100.00 100.00 100.00 100.00 100.00
B. Crop yields from Turner, Beckett and Afton
Calories %
Source of kcal 1700 1750 1800 1850 1909-13 1700 1750 1800 1850 1909-13
Cereals 1,461 1,176 1,363 1,437 999 65.54 52.55 55.90 56.46 33.55
Fish 24 24 24 24 32 1.07 1.06 0.97 0.93 1.08
Fruit and vegetables 167 169 231 338 476 7.50 7.55 9.49 13.27 15.98
Meat and dairy products 538 786 708 599 1,075 24.13 35.13 29.02 23.54 36.12
Other 39 83 113 147 395 1.77 3.71 4.62 5.80 13.27
Total 2,229 2,237 2,439 2,544 2,977 100.00 100.00 100.00 100.00 100.00
Table 4.10. Sources of calories, by food group, in England and Wales, 1700-1909-13.
Notes. We have calculated that the average daily consumption of ‘cottage produce’ in 1909-13 was equal to 135 calories per head. The Royal Society estimated that the total number of calories from this source was equivalent to one-half of the calories obtained from home-produced poultry, eggs and vegetables, and one-third of the calories obtained from home-produced fruit. We have used these figures to estimate the proportion of the calories derived from ‘cottage produce’ which may be allocated to each of the other categories. For further information, see Parliamentary Papers 1917: 7.Sources: See Tables 4.7-4.8.
21
Other causes of health improvement• Disease virulence (scarlet fever; tuberculosis?)
• Housing
• Environmental improvement
• Sanitary reform
• Immunisation campaigns
• Therapeutic interventions
22
Cohorts and mortality decline
Source: Kermack, McKendrick and McKinlay 1934: 699.
23
Cohorts and mortality decline, cont.
Cohort-specific male mortality: England and Wales, 1824-1957
0
20
40
60
80
100
120
5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85&OVER
age
Morta
lity ind
ex (18
34-47=
100)
1824-1837 1839-1852 1854-1867 1869-1882 1884-1897 1899-1912
1914-1927 1929-1942 1944-1957
Cohort-specific female mortality: England and Wales, 1824-1957
0
20
40
60
80
100
120
5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85&OVER
age
Morta
lity ind
ex (18
34-47=
100)
1824-1837 1839-1852 1854-1867 1869-1882 1884-1897 1899-1912
1914-1927 1929-1942 1944-1957
24
Food and economic development
Calories
Basal metabolism
Physical Activity Level (1.27BMR)
Work and other activity
25
Food and economic development, cont.
DecileBMI
(kg/ m2) Stature (m)Weight
(kg)kcal for
BMR
kcal consumpti
on PAL(1) (2) (3) (4) (5) (6) (7)
Highest 26.68 1.80 86.04 1,995 5,244 2.639 24.12 1.75 73.77 1,808 4,258 2.368 22.89 1.72 68.09 1,721 3,822 2.227 21.96 1.71 63.88 1,656 3,509 2.126 21.16 1.69 60.33 1,602 3,251 2.035 20.42 1.67 57.06 1,552 3,019 1.954 19.68 1.65 53.86 1,503 2,797 1.863 18.88 1.64 50.49 1,452 2,568 1.772 17.92 1.61 46.51 1,391 2,305 1.66
Lowest 16.20 1.56 39.63 1,285 1,872 1.46
Medium egalitarianisms/ x = 0.3
Notes: PAL means a person’s daily activity level as a multiple of BMR. It is assumed that the log of BMI is normally distributed with mean 21 and standard deviation 3 [BMI~LN (21, 3)], and that stature is normally distributed with mean 1.68 meters and standard deviation 0.066 meters [Stature~N (1.68, 0.066)]. Column 4: Col. 2 × (Col. 3 squared), Column 5: computed from Equation (A.7), Column 6: The size distribution of calories is from Column 4 in Table 2.4, and Column 7: Col. 6 ÷ Col. 5. Note that some figures are subject to rounding.
Source: Floud, Fogel, Harris and Hong 2011: 73
26
Food and economic development, cont.
Year of birth 1777.5 1827.5 1886-93Age at measurement
23 23 20-24
Year of measurement
1800.5 1850.5 1910-13
Height (cm) 168.83 172.87 168.80Weight (kg) 59.08 61.94 61.40BMI (kg/m2) 20.73 20.73 21.55BMR (kcal/hr) 65.95 67.78 67.05Calories p.c.u. 3,271 3,337 3,893Calories for light work
2,436 2,503 2,476
Calories for moderate work
2,816 2,894 2,863
Calories for heavy work
3,377 3,470 3,433
For notes and sources, see Floud, Fogel, Harris and Hong 2011: 167, 169.
27
They're taller, better fed and have fewer fillings - so why are today's children LESS healthy than 50 years ago?(Daily Mail, 7/6/11)
http://www.dailymail.co.uk/health/article-1395040/Theyre-taller-better-fed-fewer-fillings--todays-children-LESS-healthy-50-years-ago.html
28
Conclusions and implications• Increases in average height reflect improvements in basic
aspects of the standard of living, such as diet and environmental conditions
• They are also associated with parallel improvements in infant and child survival rates
• All of these improvements have contributed to economic growth in Britain and other countries and, consequently, to the welfare of succeeding generations
• They also have long-lasting implications for adult health and longevity (see e.g. Barker and Osmond 1986, etc.)
29
Conclusions and implications, cont.
Chronic disorder 1910 Union Army veterans
Age-adjusted 1983 veterans
NHIS 1985-8 veterans
NHIS 1997-2006 veterans
Musculoskeletal 67.7 47.2 42.5 34.2
Digestive 84.0 48.9 18.0 1.9
Diarrhoea 31.9 4.2 1.4 2.5
Genitourinary 27.3 32.3 8.9 2.1
Central nervous, endocrine, metabolic or blood
24.2 29.1 12.6 6.2
Heart 76.0 39.9 26.6 19.4
Respiratory 42.2 28.1 26.5 15.1
Comparison of the prevalence of selected chronic conditions among Union Army veterans in 1910, veterans in NHIS, 1985-8, and veterans in NHIS, 1997-2006
Source: Floud, Fogel, Harris and Hong 2011: 345.
30
Conclusions and implications, cont.
•Supplemental Figure 2. Male (blue squares) and female (red circles) life expectancy in the record-holding country, based on the annual data shown in supplementary table 1. For males the fitted line has a slope of 0.222 and r2 = 0.980
Source: J. Oeppen and J. Vaupel, ‘Broken limits to life expectancy: Supplementary material’, Science, 10 May 2002 (http://www.sciencemag.org/content/296/5570/1029/suppl/DC1).