The changing body Health, nutrition and human development in the western world since 1700 Bernard Harris 30 June 2011.

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)

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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

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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)

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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.

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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

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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

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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)

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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

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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.

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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.

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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

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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

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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.)

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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).