The Changing Body: Health, Nutrition and Human Development in the Western World since 1700

This contribution to a topic that is rarely out of the news for long is by four distinguished scholars, each an expert in his field, and one of them, Robert Fogel, is a winner of the Nobel prize for economics. Volumes produced as cooperative ventures can sometimes appear disjointed, but this is not the case here. There is a pleasing unity in style and presentation that suggests a firm editorial hand, which is an important quality in a book that makes extensive use of statistical tables and, on occasion, of mathematical formulae.

First the good news. In 1950, in 16 predominantly West European countries, the average 65-year-old could look forward to 13.69 more years of life. By 2000, it had risen to 17.5 years. There is less agreement on the extent to which the extra years are worth having. Is it the case that they are characterised by misery, illness and decrepitude, or do our final years have a reasonable chance of being happy and active? The answer is not entirely clear, with some evidence from the Netherlands suggesting that morbidity-free life expectancy in that country actually fell by 4.3 years for women and 0.8 years for men in the last decade of the 20th century, although this appears to have been an isolated finding that was contradicted elsewhere.

The bad news concerns humanity's ability to replace one problem with another or, in the words of the authors, we "underestimate the capacity of European populations to engage in activities which are deleterious to health such as cigarette smoking and excessive food consumption". As smoking has declined in the West (although not the East, where it is on the rise) an epidemic of obesity has taken over. Until 1950, increases in weight in relation to height were producing a healthier body mass index (weight in kilos divided by the square of height in metres), reflecting the fact that Western humanity at least was overcoming centuries of inadequate diet. However, in the final two decades of the 20th century we became overfed and undernourished as our appetites for fatty, sugary foods combined with a less active lifestyle at work and in our leisure pursuits have ensured that many people are overweight while in some regions almost a third are obese.

The authors are more encouraging in their view of the widely forecast food shortage that, Malthus-like, is supposed by some writers to be advancing upon us. They observe that agricultural productivity is at present so low in much of Africa, Asia and Latin America that even a modest advance towards Western levels would bring great benefits. And they are not referring so much to increases in the use of fertilisers or genetically modified crops as to improvements in the methods by which products are moved from field to mouth without wastage owing to decomposition and disease.

This book is an invaluable source of information for those who are concerned with the health of humanity, although it is not for the faint-hearted. Reference has already been made to the extensive use of statistics and formulae and the authors are also inclined to use expressions such as "technophysio" that sent this reader, at least, scurrying to dictionaries and medical reference books. A glossary would help. Chapter five refers to the period 1700-2100; I assumed that the latter date was a misprint on my pre-publication copy and should have read 2010. Apparently it is intentional, although I still don't understand why.