What Can We Learn from Civil War Veterans about Chronic Conditions?

Earlier this month economic historian Robert Fogel died after a short illness at the age of 86.  He was awarded the Nobel Prize in economics in 1993 “for having renewed research in economic history by applying economic theory and quantitative methods in order to explain economic and institutional change.”  Much of his recent work focused on the theory of technophysio evolution.  Well, I had never heard of it either, until reading about it recently while working on the 6th edition edits of my health economics book.  Fogel argues that the advances in human physiology experienced in the past 300 years are not the result of a genetic shift, but the result of environmentally induced changes.  In other words, advances in life expectancy and morbidity are due to improvements in nutrition, public health, medical care, labor-saving technologies, and higher incomes.  His research using data from developed and less developed countries creates an image of the changing nature of human biology.  Having largely defeated the scourge of malnutrition, the western world has seen a doubling of life expectancies and a 50 percent increase in average body size.  Today, even developing countries are beginning to experience similar gains. 

The empirical evidence for Fogel’s theory came from the examination of detailed health and demographic records from 45,000 Civil War veterans who fought in the Union Army.  The most dramatic discovery was the sheer number of chronic health conditions that the typical veteran suffered.  One in four was sent home because of a physical disability, either a hernia, arthritis, TB, or heart problems.  By 1910, two-thirds suffered from arthritis and three-fourths had heart disease.  The comparable numbers for World War II veterans at age 65 was 48 and 39 percent. 

The commonly-held belief had always been that survivors who reached old age in the early 19th century were likely to be relatively healthy.  Fogel shattered that misconception with the fact that the Civil War veterans had an average of 6.2 chronic conditions.  Today, white males who reach age 65 have an average of two chronic conditions. 

The reasons for the significant improvements in health begin early in life.  Infant and adolescent health and along with it survivability have improved substantially.  Undernourishment and infectious diseases, particularly early in life, have been virtually eradicated.  What does this tell us about the future in terms of life expectancy and morbidity?  How will further improvements affect medical care, public health, and retirement?  According to Fogel’s forecasts, an individual born in the 1990s has a 50 percent chance of living to celebrate his or her 100th birthday.  And those advances responsible for the longevity were already in place before ObamaCare.

The economics profession has lost one of the greatest minds we have had the priviledge of knowing.  May he rest in peace. 


The opinions expressed in this blog post are mine alone, and do not reflect the opinions of Baylor University.   Baylor is not responsible for the accuracy of any of the information provided in this post.