It is easy to assume that longevity improvements owe everything medicine. Medical science has afterall made huge strides over the past hundred years. In fact huge improvements are being made in other ways.

As prosperity increases governments realize their citizens have become more valuable. The UK Government announced this week that the underlying UK population will start to decline next year. The only source of growth will be immigration. The average UK household will pay £826,000 in tax over its lifetime, according to last year’s figures. For nearly a million pounds of tax revenue Governments will to act. Citizens will become even more valuable.

The Public Health and Agricultural Revolutions

The summer of 1858 in London was hot. The temperatures reached thirty five degrees. The smell of untreated human waste and industrial effluent from the tanneries became known as “The Great Stink”. Much of the smell came from the river Thames. The government, sitting in the House of Parliament next to the river, could not function. The outcome was a bill enabling the building of sewers and a pumping station system. This has served London until the present day.

Angus Deaton, the economist, coined the expression “the Great Escape”. He used it to describe the release of humanity from poverty, disease, and early death. Great Britain lead the Industrial Revolution. Because of this, it was the first country to “escape”. The emergence of the water powered mills, the foundries and the spinning engines , started Great Britain on its Great Escape. The second wave of the industrial revolution was powered by the steam engine. This drove an explosion in national income from the start of the nineteenth century. That prosperity enabled a UK Public Health focus on water, sewage, and communicable diseases. The initial bill for the London sewage system was £3m. In today’s money that is over a third of a billion pounds. The parliamentary bill passed in six weeks.

Personal hygiene improved and so did the acceptance of the “germ theory” of disease. The theory was first proposed hundreds of years earlier. It gained ground after the pioneering work of Pasteur and Koch in the later 1850’s. The London sewage system eradicated cholera. It vindicated those that had claimed cholera was water born. This was truly a Public Health Revolution. It could stand alongside the Industrial and Agricultural Revolutions.

In the period from 1700 to 1850 the average calories per day per person in the UK hardly improved. It rose from 2250 to close to 2500 in one hundred and fifty years. After that there is a steady and more rapid increase to today’s level of around 3250 calories. The Agricultural Revolution drove much of the increase in food production. Initially simple things meant more could be produced from the same land. Crop rotation and improved ploughs made a big difference. The industrial revolution provided steam engines. They could be used to replace human and animal power and drive productivity even higher. All this took place before the discovery of better strains of crops. Better nutrition reduced famine. More importantly it increased the disease resistance of the whole population.

Government Regulation

As the value of the people goes up, government is prepared to legislate to protect them. Work in the factories was hard and dangerous at the start of UK industrialization. Starting in the nineteenth century the UK Government legislated to protected workers and particularly children. The result was a massive decline in industrial accidents. At the same time, the reality of the slums that had been created in the cities became unacceptable. Governments and charities worked ceaselessly to improve them. All improved life expectancy.

As lives become more valuable governments apply safety standards to any emerging technology. For example take driving. Dashboard padding, seat belts, together with speed limits, have reduced the chance of death by car accident. The incidence of US automotive deaths have declined forty-fold since 1921. This is a remarkable reduction given that miles driven has increased over two hundred-fold since then.

Deaths in the home also plummeted in the twentieth century. Building regulation controls everything from handrails to fire retardants and fire escapes. It has made a huge difference. For example, a typical US firefighter will see just one burning building every other year. The bulk of the work undertaken are medical emergencies. Most of the rest are small fires.

Unfortunately, it is to the poor and marginalized part of any society that death comes early. A market economy is one of the best ways of reducing poverty as jobs and income spread. It can do nothing for those who cannot work. The young, the old, the sick and those whose skills are no longer needed cannot benefit. Instead Governments increasingly help directly. They can improve the lives and health of these groups by allocating tax revenue. Since the beginning of the twentieth century, Great Britain has allocated a greater and greater percentage of GDP to “Social Spending”. This accelerated from 1930 onwards and has grown almost in a straight line to twenty percent of GDP .

The extent in the improvement can best be summarized with a paragraph from Pinker’s book on the Enlightenment

“Over the course of the 20th century, Americans became 96 percent less likely to be killed in a car accident, 88 percent less likely to be mowed down on the sidewalk, 99 percent less likely to die in a plane crash, 59 percent less likely to fall to their deaths, 93 percent less likely to die in a fire, 90 percent less likely to drown, 92 percent less likely to be asphyxiated , and 95 percent less likely to be killed on the job”

(Pinker S. , 2018) p323

Making the Great Escape a Global Phenomenon

Longevity is improving all over the world. Great Britain started earlier and without many of the improvements in medical science. Vaccination for common childhood disease only started in the nineteen fifties. Countries starting later can harness all the public health and medical knowledge at the same time.

International charities and NGO’s spread the message about clean water and Public Health. Other NGO’s are accelerating the Agricultural Revolution. If the governments don’t act other people do. Multi-national businesses enforce factory safety and rules against child labour in their supply chains. Longevity and reductions in child mortality are rapidly equalizing around the world.

As populations plateau and then decline, every citizen capable of working will be needed. Moving workers around through migration will become a zero sum game. Governments will increasingly learn to treasure and protect their people.

Pinker,S. “Enlightenment Now”, Penguin, London