1. The Great Escape: how societies increased health, wealth and happiness CENV 110

2. Trends in human well-being What constitutes well-being Basic human necessities –Food –Clothing –Shelter Other important factors –Health, life expectancy, child mortality –Culture –Leisure time

3. Small groups List what your group believes would be the three best “measures” of well-being

4. Some examples Life expectancy Income Political Freedom Social equality Environmental quality

7. The life of man, solitary, poor, nasty, brutish, and short. Thomas Hobbes The Leviathan

8. The ladder of life and measuring happiness Imagine a ladder with 11 steps of happiness Top is “best possible life” Bottom is “worst possible life”

13. Does money buy health? Globally richer countries are healthier But: Chile and Costa Rica have about the same health as the U.S., but spend 12% as much per person

14. Trends in number of poor people

15. Do rich countries get richer?

18. What was responsible for the increase? By 1850 clean water was generally available so once you reached 40 you had a good life expectancy Disposal of sewage to prevent the spread of disease (especially diarrhea) Changes in mortality of children Note that this was before antibiotics, vaccination It was due to better nutrition and living conditions and understanding disease transmission People were skinny and short

19. But it can’t be largely diet Because rich people did not survive longer until about 1750 The industrial revolution brought people to cities which were very unhealthy places Sewage was rampant, pollution was rampant, and clean water hard to find It is this period 1750-1850 where the health of the wealthy increased while the poor did not

20. Big changes in the mid 19 th century John Snow 1813-1858 Founder of modern epidemiology Showed that a cholera outbreak in London was largely coming from a single water pump that was contaminated. This work led to public works to provide clean water and to stop sewage being dumped everywhere.

21. Louis Pasteur Louis Pasteur 1822-1895 Founder of microbiology, invented vaccines for rabies and anthrax Founded the germ theory of disease, pasteurization of milk etc.

22. Ignaz Semmelweis 1818-1865 Austro-Hungarian doctor who showed that childbed fever which killed many women after childbirth was due to disease transmission by doctors. Showed that the use of antiseptics and hand cleaning prevented this disease

24. Why did the rest of the world catch up so fast It is not complex modern medicine that increases life expectancy so much It is public health – which is straightforward and generally cheap

25. Changes in average height

26. Changes in height in Japan Men Women

27. Equity Does a rising tied lift all boats?

28. US

29. In the U.S. the rich get richer

30. So what caused the great escape?

31. Health Scientific knowledge –Importance of clean water –Germ theory of disease Government action –Public health programs Better nutrition –Economic development –The green revolution Less war

32. Wealth Technological development –Scientific advances –The industrial revolution Better governance Increased trade

33. Culture, freedom and welfare Less despotism More wealth – more leisure and travel Improving air and water quality (in some places) The internet?

34. Study guide Draw a graph where the X axis is GDP (income per person) and the Y axis is peoples rating of their happiness going from 1 to 11. Draw the general relationship from the data presented in class. In the last 30 years which countries have grown their economy the fastest?. Which the slowest? What were the differences or similarities in life expectancy at birth in rich and poor families in England in 1500. Draw the following graph. X axis is calendar year going from 1850 to 2000. Y axis is life expectancy. Scaled from 0 to 80 years. Draw the trend for the U.S. population of life expectancy at birth. Where did it start in 1850 and where is it now? Draw a trend for the life expectancy if you reached 70 years of age? What are the key elements of modern public health? What is the trend in the height of people in the last 50 years and what country now has the tallest people in the world? What is the trend in the proportion of the U.S. population in poverty in the last 40 years What has been the trend in the last 100 years of the proportion of US income obtained by the top 1% income group What are the key factors that have led to increased health and life expectancy around the world in the last 200 years ?