Robert William Fogel Interview: Conversations with History; Institute of International Studies, UC Berkeley
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Let's talk a little about the work you've done on aging. Bringing this data to bear on the questions you're interested in about aging, what did you conclude about the causes of the differences in the onset of these chronic illnesses?
We concluded that we should apply for another grant! And we have. So we're still working on it.
We have some conclusions, but most of the research is ahead of us. We've been invited by the National Institute of Aging to engage in a parallel project which we call "Explaining the Decline in Disabilities during the Twentieth Century," which means that the data the we already have is not adequate to answer all the questions. It was adequate to identify that there had been a change, but not adequate to identify why.
Nevertheless, we have some preliminary hypotheses, and I spoke about those in my first Hitchcock Lecture. We believe that the principal explanation to the increase in life expectancy and the reduction in disabilities during the course of the twentieth century is the cleaning up of the environment, that the exposure to very severe "health insults" (to use an epidemiologist's word) did long-term damage to the physiology of the people who were exposed to them.
This is at birth? Or in the early stages in life?
It includes in utero, but it's throughout the life-cycle. But the years of early childhood are the most sensitive years when organs are still developing. Even if no new cells are being added, the cells are getting bigger. That's why we get bigger. Our cells get larger. In some systems, like the central nervous system, new cells keep getting added throughout the developmental ages. That means if you have processes which interfere with cellular formation, you may have deficits in the organs that are not [immediately] apparent, but take the form of earlier breakdown. There have been a number of studies in the United States and several countries in Europe, and in India, among others, that reveal a high correlation between characteristics of the fetus at birth and characteristics of development during the first year of life that predict such things as the odds of having high blood pressure or Type II diabetes or chronic respiratory disease in your fifties and sixties.
Is one preliminary conclusion that health expenditures devoted to early child care could be an important way to address some of these problems?
Yes, that's a definite policy implication that's arisen from this work. Not just early child care, but prenatal care as well. The prenatal period and early childhood period, investments in good health, including counseling of mothers -- getting women who smoke to stop smoking, getting women who drink to stop drinking during pregnancy, and to eat appropriately. All those things will lead to healthier fetuses, and healthier infants, and healthier life throughout the development ages and into middle and old age.
Your work transcends economics and history. It's quite interdisciplinary in terms of all the fields of knowledge that come to bear in reaching these kinds of conclusions.
That's right. I spend more of my time these days with doctors than I do with economists. Although, don't get me wrong, I love economics.
You use a term in your lecture and in your book, the theory of "techno-physio evolution." Talk a little about that, because it points to the insights that are coming from all these different fields about what has created the conditions for this change in people's health.
One of the things that we've done in our search for evidence bearing on the explanation for the enormous increase in life expectancy over the past three centuries has been to identify physiological changes that may have explanatory power. In this connection, one of the most important measures is a class of measures called anthropometric measures. They're physical characteristics of the body such as height, sitting height, the amount of fat that you have on your body, the amount of lean body mass, a measure called the Body Mass Index, which is weight standardized for height.
Improvement in these anthropometric measures has been shown to be highly correlated with the increase in life expectancy and the reduction in morbidity over time and over the life cycle. A person born in 1950 has twice the life expectancy, more than twice, two-and-a-half times the life expectancy of someone who was born in 1700. So over 300 years, we've doubled life expectancy, we've increased average weight by 50 percent, and we've added nearly a foot to stature. What goes along with the difference in these external measures are stronger lungs, stronger hearts, improved respiration, stronger electrical signals across membranes -- so, in every respect that we've been able to measure with high-tech [instruments]. Unfortunately, there are still people who are as badly off in physiology because of malnutrition and exposure to disease in very poor countries as the French were before the French Revolution.
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