Stature and Health

In conventional terms the standard of living has become practically synonymous with a material standard, and consequently the concept has most often been equated with and measured by per capita income. Yet it can be interpreted much more broadly to encompass the psychological and biological dimensions of human existence (i.e., the quality of life in all of its manifestations). Distinguishing among these components of well-being would not add much that is conceptually meaningful to our understanding of the past if they all correlated positively and perfectly with one another. But recent empirical evidence has tended to show the importance of not conflating them into one concept.

Historians have begun to explore ways to illuminate this issue from another perspective, namely by considering the biological standard of living as an equally valid measurement of human well-being (Komlos 1989). One approach has been to study the health of historical populations, though this avenue is obviously limited by the scanty systematic evidence at our disposal (Riley and Alter 1986). Another approach has been to consider mortality an integral component of welfare and, in fact, to incorporate mortality into the conventional index of the material standard of living (Williamson 1981, 1982; Davin 1988). Yet this attempt to collapse the biological and material standards of living into a single index is vexed by the inherent difficulty of gauging the monetary value of human life.

Still another promising approach, and one with an abundant evidential basis from the seventeenth century onward, is anthropometric history, meaning the analysis of secular changes in human height, weight, and weight for height (Tanner 1981; Fogel 1987; Komlos 1987; Ward 1987; Riggs 1988; Cuff 1989; Floud and Wächter 1989). This way of looking at the issue acknowledges outright the inherent multidi-mensionality of the standard of living, and furthermore assumes that the several dimensions might be orthogonal to one another, which is to say that they generally cannot be collapsed into one indicator. The agenda of this research program is to construct indexes of the biological standard of living of various populations over time, by social class and gender if possible, and to ascertain how this indicator correlates with the material standard of life conventionally conceived.

Anthropometric measures are an important part of this research program, because they enable one to quantify nutritional status, which hitherto has eluded historians. This line of reasoning is based on medical research, which has established beyond doubt that the net cumulative nutritional intake of a population has a major influence on its average height, with maternal nutrition also playing a significant role (Fogel, Engerman, and Trussel 1982; Falkner and Tanner 1986). Thus, height at a particular age, as well as the terminal height attained by a population, is a measure of cumulative net nutrition: the food consumed during the growing years minus the claims on the nutrients of basal metabolism, of energy expenditure, and of encounters with disease (Tanner 1978). As nutritional status increases, more calories and protein are available for physical growth, and the closer individuals and populations come to reaching their genetic potentials of height.

The terminal height an individual reaches in a given population is also influenced by genetic factors, but this consideration does not affect studies of the evolution of human height as long as the genetic composition of the population is not dramatically altered by large-scale migration.

Holding the genetic composition of the population constant, nutritional status, measured by height, is at once an indicator of exposure to disease and of health in general. It correlates positively with food consumption and with life expectancy, and consequently shows how well the human organism thrives in its particular economic, epidemiological, and social environment (Friedman 1982). Consequently, height is a much more encompassing variable than are real wages and has the advantage in a historical context of being available for groups, such as subsistence peasants and aristocrats, for whom real wages are not pertinent.

Food consumption in prior centuries was the major component of total expenditure (Cipolla 1980), and therefore height can also be used as a proxy for real income. The positive relationship between height and income has been amply documented for twentieth-century populations, for which both variables are available (Steckel 1983; Brinkman, Drukker, and Slot 1988). Yet some caveats are in order. The distribution of income has been found to affect the mean stature of a population. Furthermore, the composition of the food consumed is also of some consequence, because the mix of calorie and protein intake is important to the growth process. This question of mix is complicated by the fact that protein is made up of many amino acids, and it is the combination of amino acids, not only their absolute quantity, that ultimately influences growth and physical well-being. Finally, food consumption obviously depends not only on real income, but also on the price of food relative to all other products. In a society in which commercialization has not proceeded very far, the availability of industrial products might be limited and therefore their prices are high. Once the availability of industrial goods increases through market integration, the structure of food consumption might change discontinuously and rapidly as a consequence of substitution. Economic development might also lead to the introduction of new products, such as coffee, tea, or sugar, that could be perceived as substitutes for some nutritious food items. This, in turn, may lead to shifts in the demand for food independently of any changes in income per capita. These constrictions indicate clearly that the analysis of the stature of a population is not a mechanical exercise.

In spite of these caveats, the results of anthropo metric research have been quite revealing. Height has been shown to correlate positively with socioeconomic variables. For instance, the height of French recruits born in the late 1840s depended on their education and wealth. Illiterates averaged 164.3 cm, whereas those able to read and write were 1.2 cm taller. Presumably literate men were wealthier and spent more time at education and less at labor than did illiterate men (Le Roy Ladurie and Bernageau 1971). Another interesting finding is that by the early eighteenth century the height of the colonial North American population was already well above European norms, which implies that the ecological (and nutritional) environment of the New World was especially favorable from the human-biological point of view (Sokoloff and Villaflor 1982). Although slaves appear to have been neglected as children, even they benefited from the abundance of food in colonial North America, because as adults their height was close to that of the white population and above that of the European peasantry (Steckel 1986). In contrast to that of early North Americans, the nutritional status of the poor boys of London seems to have been truly miserable at the end of the eighteenth century. They were shorter than practically all modern populations, with the possible exception of such groups as the Lume of New Guinea (Eveleth and Tanner 1976; Floud and Wachter 1982).

Yet there were several instances in which the trends in heights and in per capita incomes diverged from one another. They occurred during the early stages of rapid economic growth: in east central Europe during the second half of the eighteenth century, in late-nineteenth-century Montreal, and in the antebellum United States. In the United States, the stature of army recruits declined by more than 2 centimeters beginning with the birth cohorts of the 1830s, even though according to conventional indicators the economy was expanding rapidly during these decades. Between 1840 and 1870 per capita net national product increased by more than 40 percent (Gallman 1972; Fogel 1986; Komlos 1987). In the Habsburg monarchy the decline in stature during the course of the second half of the eighteenth century was at least 3 but more nearly 4 centimeters. A similar pattern was found for industrializing Montreal. The birth weight of infants there fell after the 1870s, indicating that the nutritional status of the mothers was declining. Such anthropometric cycles were not known to exist previously (Ward and Ward 1984; Komlos 1985).

Determining the extent to which these episodes were accompanied by a deterioration in the epidemiological environment requires further study, but it is already clear that all three were, in fact, characterized by a decline in per capita nutrient intake. In the New World, periods of nutritional stress were accompanied by rapid economic growth, during which, by conventional measures, the material standard of living was rising. This might be considered an anomaly because an increase in per capita income normally implies that food consumption, too, is rising. It becomes less anomalous, however, once one notes that although income determines the position of the demand curve for food, an individual who purchases food at higher market prices might consume less of it than a self-sufficient peasant isolated from the market by high transport and information costs, even if the measured income of the former is larger than that of the latter. Moreover, contemporaneously with the decline in human stature in the antebellum United States, the crude death rate was increasing even as per capita income was rising, supporting the notion that the biological standard of living was declining (Pope 1986).

The divergence in biological and conventional indicators of well-being can be explained by several other factors. The examples of economic growth already provided were accompanied by rapid population growth and by urbanization. This increased the demand for food at a time when the agricultural labor force was growing more slowly than the industrial labor force and the gains in labor productivity in agriculture were still small. Hence, supply did not generally match the increased demand for food, and food prices rose relative to those of all other goods.

The relative price of food also rose because rapid technological change in the industrial sector brought with it a decline in all other prices. The rise in the relative price of food was greatest in areas that had previously been isolated from industrial centers. Early stages of growth were generally accompanied by market integration, and this meant that in some regions the price of food, relative to that of all other goods, rose sharply. This brought with it the potential for large movements along the demand curve for food in these regions. In addition, new products changed consumers' tastes and might also have been seen as substitutes for traditional food products. Thus, although the real wage might have risen in the industrial sector, it did not rise as fast as food prices. Even farm operators whose income rose as fast as food prices decreased their food consumption because the price elasticity of demand for food was greater than the income elasticity.

In east central Europe the fall in nutritional levels was initiated not by sectoral shifts from the agricultural to the industrial sector, but by rapid population growth pressing on scarce resources. In contrast to the situation in the United States, in Europe the quantity of land was fixed, and therefore population growth ran into Malthusian ceilings (Komlos 1985). The subsequent limited quantity and the rise in food prices meant a fall in consumption, particularly of meat products, because the price of a calorie is much greater if purchased through meat than if purchased through grain. This fall in the intake of animal protein, an important component of nutritional status, made it more difficult for the body to fight off nutrition-sensitive diseases. Of course, during the early stages of economic growth, individuals were usually not well informed about the importance of a balanced diet and therefore were unaware that changing their food habits would impinge on their nutritional status and health.

To be sure, not all members of the society experienced nutritional stress during the early stages of economic development. In the United States the income of the urban middle class rose sufficiently in the 1830s and 1840s to keep pace with the rise in the price of foodstuffs and, at least initially, to permit that group to maintain its nutritional status. Not until the Civil War disrupted the flow of nutrients did their biological well-being begin to suffer as well. In a similar fashion, Habsburg and German aristocrats were not affected by the Malthusian crisis of the eighteenth century, but rather increased their height advantage considerably compared with the lower classes (Komlos 1986, 1990).

Height therefore correlates positively with social class. In Germany, aristocrats were 3 to 7 centimeters taller than middle-class boys throughout adolescence. The latter in turn were about 8 centimeters taller than boys with lower social standing of the same age. Boys attending prestigious military schools in Austria, England, France, and Germany were all much taller than the population at large. For instance, adolescents of the English gentry were at least 20 centimeters taller than the nutritionally deprived slum boys of London (Floud and Wachter 1982; Komlos 1990).

Yet another pattern is that propinquity to nutri-

ents is a crucial determinant of nutritional status in preindustrial societies and in societies caught in the early stages of economic development. In such circumstances per capita income is not as important a determinant of human stature as is the availability of food. In the eighteenth-century Habsburg monarchy, recruits from areas with a large agricultural sector, even if the economy was relatively underdeveloped, were well nourished by the standards of the time compared with those from industrially more advanced provinces. Being isolated from markets by high transportation and transactions costs had its advantages as long as population density did not exceed the carrying capacity of the land, because the subsistence peasant families had little choice but to consume all of their own food output. Once they became integrated into a larger market, however, rising food prices and their sales of agricultural commodities tended to impinge on their own food intake.

Similarly in the antebellum United States, white southern men were 1.5 centimeters taller than their counterparts in the more industrial North, even though per capita income was greater in the latter region (Margo and Steckel 1983). The same pattern held between England and its colonies. Although in the eighteenth century England had a higher per capita income, perhaps by as much as 25 percent, its soldiers were considerably shorter than their counterparts in the British colonies of North America. A century later, Irish-born recruits into the Union army during the Civil War were also taller than soldiers born in England, although English per capita income was certainly higher than that of the Irish (Mokyr and O'Gràda 1988).

Indeed, the importance of remoteness for nutritional status can be seen from the fact that in 1850 the tallest population in Europe was probably found in Dalmatia, one of the least developed areas of the Continent. This relationship reappears in an astounding form at the end of the century: Although Bosnia-Herzegovina was certainly among the least developed parts of the Habsburg monarchy, its population was nonetheless the tallest (Austrian Bureau of Health 1910).

All of this evidence corroborates the notion that being close to the supply of food during the early stages of industrialization had a positive effect on nutritional status, possibly because the costs of obtaining food were lower. In addition, rural populations doubtless benefited from a lower exposure to disease than those crowded into an urban en vironment. Another probable reason for the difficulty of maintaining nutritional status during the initial phase of economic development is that income distribution is more uneven during such phases than at other times. The changes in entitlement to goods, with the rise in food prices, cause many to lose their ability to "command food" (Sen 1981).

In summary, because height is a good proxy for nutritional status, it is employed to measure the biological well-being of populations of the past. The biological standard of living indicates the extent to which ecological circumstances are favorable to the functioning of the human organism. The concept encompasses such aspects of human biology as life expectancy, morbidity, and public health. Moreover, in the developed economies of the twentieth century, height correlates positively with per capita income not only because of the rise in food intake, but also because of improvements in public health and medical technology.

Yet the evidence presented here also implies that economic growth can be accompanied by a fall in nutritional status. Hence, the biological standard of living can diverge from real incomes during the early stages of industrialization. This pattern is not anomalous, because gross national product has generally grown more rapidly than the agricultural sector, and in some cases per capita food consumption has fallen. But it does mean that per capita income can be an ambiguous measure of welfare during the early stages of economic development. A rise in average per capita income is of ambiguous benefit if it is distributed unevenly and if some members of the population lead less healthy lives as a by-product of economic change. Of course, in the long run the ambiguity disappears, because the productivity of the agricultural sector improves and relative food prices decline. Hence, the share of food in consumer budgets fell in Europe from about 75 percent to about 25 percent, or even less, of income. Yet for the early stages of industrialization recent anthropometric research indicates that the conventional indicators of welfare are incomplete; they must be supplemented with a measure, such as human stature, that illuminates the biological well-being of a population.

John Komlos

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