Medicine has made enormous strides since Nathan Rothschild’s time. But better, more efficacious medicine—the treatment of illness and repair of injury—is only part of the story. Much of the increased life expectancy of these years has come from gains in prevention, cleaner living rather than better medicine. Clean water and expeditious waste removal, plus improvements in personal cleanliness, have made all the difference. For a long time the great killer was gastrointestinal infection, transmitted from waste to hands to food to digestive tract; and this unseen but deadly enemy, ever present, was reinforced from time to time by epidemic microbes such as the vibrio of cholera. The best avenue of transmission was the common privy, where contact with wastes was fostered by want of paper for cleaning and lack of washable underclothing. Who lives in unwashed woolens—and woolens do not wash well—will itch and scratch. So hands were dirty, and the great mistake was failure to wash before eating. This was why those religious groups that prescribed washing—the Jews, the Muslims—had lower disease and death rates; which did not always count to their advantage. People were easily persuaded that if fewer Jews died, it was because they had poisoned Christian wells.
The answer was found, not in changed religious belief or doctrine, but in industrial innovation. The principal product of the new technology that we know as the Industrial Revolution was cheap, washable cotton; and along with it mass-produced soap made of vegetable oils. For the first time, the common man could afford underwear, once known as body linen because that was the washable fabric that the well-to-do wore next to their skin. He (or she) could wash with soap and even bathe, although too much bathing was seen as a sign of dirtiness. Why would clean people have to wash so often? No matter. Personal hygiene changed drastically, so that commoners of the late nineteenth and early twentieth century often lived cleaner than the kings and queens of a century earlier.
The third element in the decline of disease and death was better nutrition. This owed much to increases in food supply, even more to better, faster transport. Famines, often the product of local shortages, became rarer; diet grew more varied and richer in animal protein. These changes translated among other things into taller, stronger physiques. This was a much slower process than those medical and hygienic gains that could be instituted from above, in large part because it depended on habit and taste as well as income. As late as World War I, the Turks who fought the British expeditionary force at Gallipoli were struck by the difference in height between the steak-and mutton-fed troops from Australia and New Zealand and the stunted youth of British mill towns. And anyone who follows immigrant populations from poor countries into rich will note that the children are taller and better knit than their parents.
From these improvements, life expectancy has shot up, while the differences between rich and poor have narrowed. The major causes of adult death are no longer infection, especially gastrointestinal infection, but rather the wasting ailments of old age. These gains have been greatest in rich industrial nations with medical care for all, but even some poorer countries have achieved impressive results.
Advances in medicine and hygiene exemplify a much larger phenomenon: the gains from the application of knowledge and science to technology. These give us reason to be hopeful about the problems that cloud present and future. They even encourage us toward fantasies of eternal life or, better yet, eternal youth.
Yet these fantasies, when science-based, that is, based on reality, are the dreams of the rich and fortunate. Gains to knowledge have not been evenly distributed, even within rich nations. We live in a world of inequality and diversity. This world is divided roughly into three kinds of nations: those that spend lots of money to keep their weight down; those whose people eat to live; and those whose people don’t know where the next meal is coming from. Along with these differences go sharp contrasts in disease rates and life expectancy. The people of the rich nations worry about their old age, which gets ever longer. They exercise to stay fit, measure and fight cholesterol, while away the time with television, telephone, and games, console themselves with such euphemisms as “the golden years” and the troisième age. “Young” is good; “old,” disparaging and problematic. Meanwhile the people of poor countries try to stay alive. They do not have to worry about cholesterol and fatty arteries, partly because of lean diet, partly because they die early. They try to ensure a secure old age, if old age there be, by having lots of children who will grow up with a proper sense of filial obligation.
The old division of the world into two power blocs, East and West, has subsided. Now the big challenge and threat is the gap in wealth and health that separates rich and poor. These are often styled North and South, because the division is geographic; but a more accurate signifìer would be the West and the Rest, because the division is also historic. Here is the greatest single problem and danger facing the world of the Third Millennium. The only other worry that comes close is environmental deterioration, and the two are intimately connected, indeed are one. They are one because wealth entails not only consumption but also waste, not only production but also destruction. It is this waste and destruction, which has increased enormously with output and income, that threatens the space we live and move in.
How big is the gap between rich and poor and what is happening to it? Very roughly and briefly: the difference in income per head between the richest industrial nation, say Switzerland, and the poorest nonindustrial country, Mozambique, is about 400 to 1. Two hundred and fifty years ago, this gap between richest and poorest was perhaps 5 to 1, and the difference between Europe and, say, East or South Asia (China or India) was around 1.5 or 2 to 1.3
Is the gap still growing today? At the extremes, clearly yes. Some countries are not only not gaining; they are growing poorer, relatively and sometimes absolutely. Others are barely holding their own. Others are catching up. Our task (the rich countries), in our own interest as well as theirs, is to help the poor become healthier and wealthier. If we do not, they will seek to take what they cannot make; and if they cannot earn by exporting commodities, they will export people. In short, wealth is an irresistible magnet; and poverty is a potentially raging contaminant: it cannot be segregated, and our peace and prosperity depend in the long run on the well-being of others.
How shall the others do this? How do we help? This book will try to contribute to an answer. I emphasize the word “contribute.” No one has a simple answer, and all proposals of panaceas are in a class with millenarian dreams.
I propose to approach these problems historically. I do so because I am a historian by training and temperament, and in difficult matters of this kind, it is best to do what one knows and does best. But I do so also because the best way to understand a problem is to ask: How and why did we get where we are? How did the rich countries get so rich? Why are the poor countries so poor? Why did Europe (“the West”) take the lead in changing the world?
A historical approach does not ensure an answer. Others have thought about these matters and come up with diverse explanations. Most of these fall into one of two schools. Some see Western wealth and dominion as the triumph of good over bad. The Europeans, they say, were smarter, better organized, harder working; the others were ignorant, arrogant, lazy, backward, superstitious. Others invert the categories: The Europeans, they say, were aggressive, ruthless, greedy, unscrupulous, hypocritical; their victims were happy, innocent, weak—waiting victims and hence thoroughly victimized. We shall see that both of these manichean visions have elements of truth, as well as of ideological fantasy. Things are always more complicated than we would have them.
A third school would argue that the West-Rest dichotomy is simply false. In the large stream of world history, Europe is a latecomer and free rider on the earlier achievements of others. That is patently incorrect. As the historical record shows, for the last thousand years, Europe (the West) has been the prime mover of development and modernity.
That still leaves the moral issue. Some would say that Eurocentris
m is bad for us, indeed bad for the world, hence to be avoided. Those people should avoid it. As for me, I prefer truth to goodthink. I feel surer of my ground.
THE WEALTH AND POVERTY OF NATIONS
1
Nature’s Inequalities
Geography has fallen on hard times. As a student in elementary school, I had to read and trace maps, even draw them from memory. We learned about strange places, peoples, and customs, and this long before anyone had invented the word “multiculturalism.” At the same time, at higher levels far removed, schools of economic and cultural geography flourished. In France, no one would think of doing a study of regional history without first laying out the material conditions of life and social activity.1 And in the United States, Ellsworth Huntington and his disciples were studying the ways that geography, especially climate, influenced human development.
Yet in spite of much useful and revealing research, Huntington gave geography a bad name.2 He went too far. He was so impressed by the connections between physical environment and human activity that he attributed more and more to geography, starting with physical influences and moving on to cultural. In the end, he was classifying civilizations hierarchically and assigning the best—what he defined as best—to the favors of climate. Huntington taught at Yale University and not coincidentally thought New Haven, Connecticut, had the world’s most invigorating climate. Lucky man. The rest of the world went down from there, with the lands of the peoples of color toward or at the bottom of the heap.
Yet in saying these things, Huntington was simply echoing the tradition of moral geography. Philosophers easily linked environment with temperament (hence the long-standing contrast between cold and hot, between sober thoughtfulness on the one hand, ebullient pleasure seeking on the other); while the infant discipline of anthropology in the nineteenth century presumed to demonstrate the effects of geography on the distribution of merit and wisdom, invariably most abundant in the writer’s own group.3 In our own day, the tables are sometimes reversed, and Afro-American mythmakers contrast happy, creative “sun people” with cold, inhuman “ice people.”
That kind of self-congratulatory analysis may have been acceptable in an intellectual world that liked to define performance and character in racial terms, but it lost credibility and acceptability as people became sensitized and hostile to invidious group comparisons. And geography lost with it. When Harvard simply abolished its geography department after World War II, hardly a voice protested—outside the small group of those dismissed.4 Subsequently a string of leading universities—Michigan, Northwestern, Chicago, Columbia—followed suit, again without serious objection.
These repudiations have no parallel in the history of American higher education and undoubtedly reflect the intellectual weaknesses of the field: the lack of a theoretical basis, the all-embracing opportunism (more euphemistically, the catholic openness), the special “easiness” of human geography. But behind those criticisms lay a dissatisfaction with some of the results. Geography had been tarred with a racist brush, and no one wanted to be contaminated.
And yet, if by “racism” we mean the linking, whether for better or worse, of individual performance and behavior to membership in a group, especially a group defined by biology, no subject or discipline can be less racist than geography. Here we have a discipline that, confining itself to the influence of environment, talks about anything but group-generated characteristics. No one can be praised or blamed for the temperature of the air, or the volume and timing of rainfall, or the lay of the land.
Even so, geography emits a sulfurous odor of heresy. Why? Other intellectual disciplines have also propagated nonsense or excess, yet no other has been so depreciated and disparaged, if only by neglect. My own sense is that geography is discredited, if not discreditable, by its nature. It tells an unpleasant truth, namely, that nature like life is unfair, unequal in its favors; further, that nature’s unfairness is not easily remedied. A civilization like ours, with its drive to mastery, does not like to be thwarted. It disapproves of discouraging words, which geographic comparisons abound in.5
Geography, in short, brings bad tidings, and everyone knows what you do to that kind of messenger. As one practitioner puts it: “Unlike other history…the researcher may be held responsible for the results, much as the weather forecaster is held responsible for the failure of the sun to appear when one wishes to go to the beach.”6
Yet we are not the wiser for denial. On a map of the world in terms of product or income per head, the rich countries lie in the temperate zones, particularly in the northern hemisphere; the poor countries, in the tropics and semitropics. As John Kenneth Galbraith put it when he was an agricultural economist: “[If] one marks off a belt a couple of thousand miles in width encircling the earth at the equator one finds within it nodeveloped countries…. Everywhere the standard of living is low and the span of human life is short.”7 And Paul Streeten, who notes in passing the instinctive resistance to bad news:
Perhaps the most striking fact is that most underdeveloped countries lie in the tropical and semi-tropical zones, between the Tropic of Cancer and Tropic of Capricorn. Recent writers have too easily glossed over this fact and considered it largely fortuitous. This reveals the deepseated optimistic bias with which we approach problems of development and the reluctance to admit the vast differences in initial conditions with which today’s poor countries are faced compared with the pre-industrial phase of more advanced countries.8
To be sure, geography is only one factor in play here. Some scholars blame technology and the rich countries that have developed it: they are charged with inventing methods suited to temperate climates, so that potentially fertile tropical soil remains fallow. Others accuse the colonial powers of disrupting the equatorial societies, so that they have lost control of their environment. Thus the slave trade, by depopulating large areas and allowing them to revert to bush, is said to have encouraged the tsetse fly and the spread of trypanosomiasis (sleeping sickness). Most writers prefer to say nothing on the subject.
One must not take that easy way out. The historian may not erase or rewrite the past to make it more pleasing; and the economist, whose easy assumption that every country is destined to develop sooner or later, must be ready to look hard at failure.9 Whatever one may say about the weakening of geographical constraints today in an age of tropical medicine and high technology, they have not vanished and were clearly more powerful earlier. The world has never been a level playing field, and everything costs.
We begin with the simple, direct effects of environment and go on to the more complex, more mediated links.
Climate first. The world shows a wide range of temperatures and temperature patterns, reflecting location, altitude, and the declination of the sun. These differences directly affect the rhythm of activity of all species: in cold, northern winters, some animals simply curl up and hibernate; in hot, shadeless deserts, lizards and serpents seek the cool under rocks or under the earth itself. (That is why so many desert fauna are reptiles: reptiles are crawlers.) Mankind generally avoids the extremes. People pass, but do not stay; hence such names as the “Empty Quarter” in the Arabian desert. Only greed—the discovery of gold or petroleum—or the duties of scientific inquiry can overcome a rational repugnance for such hardship and justify the cost.
In general the discomfort of heat exceeds that of cold.* We all know the fable of the sun and wind. One deals with cold by putting on clothing, by building or finding shelter, by making fire. These techniques go back tens of thousands of years and account for the early dispersion of humanity from an African origin to colder climes. Heat is another story. Three quarters of the energy released by working muscle takes the form of heat, which the body, like any machine or engine, must release or eliminate to maintain a proper temperature. Unfortunately, the human animal has few biological devices to this purpose. The most important is perspiration, especially when reinforced by rapid evaporation. Damp, “sweaty” climes reduce the cooli
ng effect of perspiration—unless, that is, one has a servant or slave to work a fan and speed up evaporation. Fanning oneself may help psychologically, but the real cooling effect will be canceled by the heat produced by the motor activity. That is a law of nature: nothing for nothing; or in technical terminology, the law of conservation of energy and mass.
The easiest way to reduce this waste problem is not to generate heat; in other words, keep still and don’t work. Hence such social adaptations as the siesta, which is designed to keep people inactive in the heat of midday. In British India, the saying had it, only mad dogs and Englishmen went out in the noonday sun. The natives knew better.
Slavery makes other people do the hard work. It is no accident that slave labor has historically been associated with tropical and semitropical climes.* The same holds for division of labor by gender: in warm lands particularly, the women toil in the fields and tend to housework, while the men specialize in warfare and hunting; or in modern society, in coffee, cards, and motor vehicles. The aim is to shift the work and pain to those not able to say no.
The ultimate answer to heat has been air conditioning. But that came in very late—really after World War II, although in the United States it was known before in cinemas, doctors’ and dentists’ offices, and the workplaces of important people such as the denizens of the Pentagon. In America, air conditioning made possible the economic prosperity of the New South. Without it, cities like Atlanta, Houston, and New Orleans would still be sleepy-time towns.
The Wealth and Poverty of Nations: Why Some Are So Rich and Some So Poor Page 2