Health and Prosperity

Efficient Health Systems for Thriving Nations in the 21st Century

Fabrice Murtin

• Publisher: Palgrave Macmillan
• Year: 2015
• ISBN:
  9781137577214
• Topic: Economics
• Subtopic: Public Finance
• Index: Economics

Murtin examines the long-term causes of health improvements over the last two centuries. Focusing on the relative importance of income and education, Murtin finds that education alone accounts for the bulk of health improvements since 1870, and explains the strong correlation between longevity and income, which is highly correlated with education. Conversely, the book shows that progress in longevity has had dramatic consequences on societies, as it reduced fertility, triggered the spread of education, spurred economic growth, and improved 'prosperity' in a way that is comparable to the long-term rise in income. Health and Prosperity sheds light on the real cost of health systems in the 21st century.

1

The Health of Nations since the Industrial Revolution

Abstract: The last two centuries have witnessed an unprecedented improvement in income and health standards. Longevity has only started to converge across countries after Second World War, yet this convergence process is deemed to continue over the next 50 years. Gains in life expectancy were primarily achieved at a lower age among lower-income countries and mostly concerned respiratory, digestive or congenital diseases. A reduction in morbidity has clearly been associated with this fall in mortality.

Murtin, Fabrice. Health and Prosperity: Efficient Health Systems for Thriving Nations in the 21st Century. Basingstoke: Palgrave Macmillan, 2016. DOI: 10.1057/9781137577214.0006.

This chapter describes global and regional trends in health since the 19th century. It reviews a large number of health indicators, including life expectancy, infant mortality, adult mortality, mortality rates by age and by disease as well as morbidity indices.

Overall, the last two centuries have witnessed an unprecedented improvement in health standards, which have started to converge across countries only after the Second World War, while this convergence process is deemed to continue over the next 50 years. The reduction in morbidity is clearly associated with the fall in mortality, as shown by longitudinal evidence from the United States and by global morbidity patterns today.

The structure of this chapter is as follows. The first section describes long-term trends in life expectancy and mortality rates. Section 2 proposes micro-simulations that illustrate the sensitivity of life expectancy to the age profile of mortality rates. Gains in life expectancy are further decomposed into the respective contributions of age-specific mortality rates. Section 3 reviews the changing nature of fatal diseases in developed and developing countries since 1950. Last section illustrates the long-term decrease in morbidity observed in the United States and it discusses the current challenges of reducing morbidity among developing countries.

1 Global trends in life expectancy 1820–2050

1.1 Trends in life expectancy at birth

The past two centuries have witnessed an unprecedented pace of economic progress in human history. According to the late Angus Maddison (2008), world real GDP per capita has been multiplied by 1.9 between 1820 and 1900 and by 4.8 between 1900 and 2000. Astonishing rates of growth after the Industrial Revolution are in stark contrast with those that have prevailed in pre-industrial times. For instance, the annual growth rate of world real GDP per capita was equal to 0.04% between 1500 and 1820, but reached 1.22% between 1820 and 2000.¹ Although economic progress has been uneven across and within continents, all societies have witnessed the consequences of the Industrial Revolution, with dramatic transformations of income and educational standards, population dynamics, political regimes and income distribution.

Accordingly, progress in life expectancy has accompanied the changes in socioeconomic standards over time. Similarly to income, life expectancy acknowledged sluggish growth over the centuries that preceded the Industrial Revolution. Evidence of this fact is scarce and partial at times where statistics were not or were barely collected. However, existing evidence for some (mostly European) countries show that, before the 19th century, life expectancy has acknowledged modest fluctuations between circa 25 and 40 years depending on the local context. As recently surveyed by Galor and Moav (2007), life expectancy was estimated at about 29 years during the Mesolithic period (20,000BC–10,000BC), 21 years during the Neolithic period (10,000BC–4000BC) where life expectancy suffered from a loss in diversity of nutrient intakes in the wake of the Agricultural Revolution (Diamond, 1997). In ancient Greece and Rome, life expectancy is deemed to have been close to 28 years (Encyclopedia Britannica, 2010), while Wrigley and Schofield (1981) report fluctuations taking place between 30 and 40 years in Britain between 1540 and 1870. In other words, the current global level of about 67 years of life expectancy has never been approached, even by far, in the history of the human species, and this performance is undoubtedly linked to the astonishing rate of technological and medical progress sparked by the Industrial Revolution.

In close connection to the growth rate of productivity, health improvements have become much faster since the late 19th century and propagated quickly to the rest of the world. To illustrate this fact, the global database on life expectancy proposed by Bourguignon and Morrisson (2002) covering the period 1820–1930 is combined with official United Nations (2008) vital statistics from 1950 to 2000, and with UN projections for the period 2010–2050 (medium scenario). As a result, Figure 1.1 offers a unique snapshot of past and predicted global trends in life expectancy, broken down by regional and economic characteristics. For the sake of simplicity, I have divided the world into eight groups: High-income countries (composed mainly of Western Europe, Australia, Canada, New Zealand and the US), Eastern European countries, Russia, Latin America, China, Eastern and Southern Asia, the Middle East and Northern Africa (MENA) and Sub-Saharan Africa.

FIGURE 1.1 World distribution of life expectancy 1820–2050

Source: Bourguignon-Morrisson (2002) and United Nations Population Division (2008).

Clearly, Figure 1.1 and Table 1.1 illustrate a marked acceleration of health improvements among high-income countries over the first half of the 20th century, followed by a deceleration after 1950. Eastern Europe and Russia have achieved a remarkable catch-up with the latter group between 1910 and 1960, but witnessed a much smaller growth pace – and even a declining trend in Russia – after 1960. Similarly, China has reduced the gap in life expectancy with most advanced countries since 1950, starting from a very low initial level.

On the contrary, Latin America and MENA displayed intermediary levels in life expectancy by world standards all over the 19th century, but the gap with high-income countries widened until 1960. Eastern and above all Southern Asia suffered from extreme levels of poverty and poor health conditions until 1930, a date after which these countries started catching up with the world’s health frontier. Tragically, Sub-Saharan Africa has displayed the slowest pace of health improvements all over the 19th and 20th centuries, most notably after 1980 and the onset of the HIV/AIDS epidemics that considerably slowed down, or even overturned, the progres...

Table of contents

• Cover
• Title
• Introduction
• 1  The Health of Nations since the Industrial Revolution
• 2  The Determinants of Health Progress after the Second Industrial Revolution
• 3  The Consequences of Health Improvement
• 4  Health and Economic Growth
• 5  The Cost of Health
• 6  Health and Prosperity
• Conclusion
• References
• Index