The Escape From Hunger and Premature Death, 1700-2100: Europe, America, and the Third World

Fogel, a Nobel Prize-winning economic historian at the University of Chicago, takes a thermodynamic approach: How many calories are available for productive work above those required to maintain basic metabolism? This perspective is useful in considering the history of economic development, since human beings, poorer than now and often near the point of starvation, have historically had much less usable energy than they do now. The average white male is two to four inches taller than he was a century ago and also has greater body mass, greatly increasing his capacity for useful work; better nutrition, health care, and environment have resulted in sharp drops in mortality, disease, and chronic disabling conditions, especially in wealthy countries. Fogel sees these trends continuing well into this century and eventually extending to developing countries such as China. He does not lament the rising share of income devoted to health, which he sees as appropriate as people live longer and devote a smaller share of income to necessities such as food. He does, however, offer constructive suggestions for improving health care delivery in the United States, focusing on reaching the poorer and less-educated segments of the population. They do not include universal health insurance, which has more to do with financing than with delivering quality health care.