Long-Term Trends in Health, Welfare, and Economic Growth in the United States

We present evidence showing that the course of economic growth and of health, as measured by stature, Body Mass Index (BMI), mortality rates, or the prevalence of chronic conditions, diverged in the nineteenth century and converged in the twentieth. To analyze the change in welfare resulting from changes in health, we estimate a Human Development Index and a Borda Ranking and we calculate Usher- adjusted incomes and the willingness to pay for a reduction in mortality risk. Prior to the Civil War the increase in income was insufficient to compensate for the decline in health, whereas improvements in health outpaced economic growth in the twentieth century. We identify numerous possible causes of the nineteenth century decline in health, including greater exposure to disease, hardship created by the Civil War, and rising inequality. Our evidence on trends in waist-hip ratio, BMI, and the prevalence of chronic conditions at older ages suggests that early life conditions may exert an impact on mortality and morbidity that is not manifest until older ages. The dramatic twentieth century improvement in early life conditions implies that cohorts who are now approaching their sixties will experience a much greater rate of increase in health and longevity than past generations.