There has been more material progress in the United States in the 20th Century than in the entire world in all previous centuries combined.

IT'S GETTING BETTER ALL THE TIME

100 Greatest Trends of the Last 100 YearsBy Stephen Moore Julian Simon

CATO INSTITUTE

Copyright © 2000 Cato Institute
All right reserved.
ISBN: 978-1-882577-96-5

Contents

List of Figures.......................................................................viiForeword..............................................................................xiPreface...............................................................................xvAcknowledgments.......................................................................xviiIntroduction..........................................................................1Section I Health.................................................................25Section II Diets and Nutrition....................................................49Section III Wealth.................................................................57Section IV The State of Poor Americans............................................73Section V The State of Children and Teens........................................81Section VI The American Worker....................................................91Section VII Leisure, Recreation, and Entertainment.................................105Section VIII Housing................................................................117Section IX Transportation and Communications......................................129Section X Invention, Innovation, and Scientific Progress.........................145Section XI The Information Age....................................................151Section XII Education..............................................................159Section XIII Safety.................................................................171Section XIV Environmental Protection...............................................183Section XV Natural Resources: An Age of Abundance.................................195Section XVI Social and Cultural Indicators.........................................207Section XVII Human Achievement in Sports............................................223Section XVIII The Remarkable Gains by Women..........................................231Section XIX The Decline of Racism..................................................241Section XX Freedom and Democracy..................................................253Section XXI The American People: The World's Greatest Resource.....................261Notes.................................................................................267Index.................................................................................287

Chapter One

SECTION I. HEALTH

"Health is the first wealth," Emerson once wrote. The health of Americans improved in ways during the 20th century that can only be described as miraculous. Death and infant mortality rates plunged; life expectancy rose by 64 percent; and almost all of the killer diseases throughout human existence were conquered over the course of the century. This was a century that can and should be celebrated as "an epidemic of life." Yes, health is the first wealth, and in few other areas of life has the human condition improved so universally.

In the 1980s and 1990s the AIDS virus has understandably frightened the public because of its fatal consequences. AIDS has served as a humbling reminder of the vulnerability of human beings to deadly contagious diseases. Throughout most of history plagues and epidemics were killers of much greater magnitude than they are today. In some cases plagues and diseases could wipe out a fourth to a half of a country's population in the span of a decade. Even as recently as the beginning of the 20th century, the death toll from infectious diseases was about 700 per 100,000 population per year. Today, despite new diseases such as AIDS, infectious diseases kill about 50 per 100,000-a stunning 14-fold reduction in death from infectious disease in this century.

Here is another example of modern health improvement. For about the past 30 years, sudden infant death syndrome (SIDS) has been an indiscriminate, traumatizing, and mysterious killer of newborns. However, better education and prevention have resulted in a threefold decline in the SIDS death rate of children under age 5 over the past 15 years and have provided huge relief and comfort to their to parents.

Humankind has made gigantic progress in enabling us to live longer and healthier lives as a result of advancements in modern medicine.

1. Lengthening Human Life

Throughout most of human history, death came at an early age-25 to 30 years was a typical lifespan. The essential element of the human condition was a day-to-day struggle to fend off death. Hence, the most amazing demographic fact-and the greatest human achievement in history in our view-is that human beings have almost won the battle against early death. We are not alone in this assessment. Several years ago the New York Times Magazine called the doubling of life expectancy since the start of the industrial revolution "the greatest miracle in the history of our species."

Longer life expectancy reflects a multitude of improvements in health care, nutrition, sanitation, safety, and wealth. Increasing life expectancy at birth from the lower 20s to the high 20s around 1750 took thousands of years. Over the next two centuries, life expectancy in the richest countries suddenly accelerated and tripled. From the mid-18th century to today, life spans in the advanced countries jumped from less than 30 years to about 75 years.

In 1900 the average life expectancy in the United States was just under 50 years. Today it is 77 years. This means that we have expanded the time horizon for a typical human life by 50 percent in the past 100 years. And life expectancy for blacks has moved up from only 30 years in 1900 to a bit less than that of whites.

Women have made greater gains in life expectancy than men in this century. In 1900 women on average lived two years longer than men. In 1950 they lived 5 years longer and today women on average live 6 years longer than men.

Life expectancy has also increased at every age. For example, a 45-year-old American could have expected to live 25 more years in 1900. Now a 45-year-old can expect to live 34 more years, as shown in the table.

The gains in life spans in industrialized countries are now also showing up in the poorest nations as well. As recently as 1950, the life expectancy of a citizen of a less developed country like China or India was about 40 years. Today it is 63 years. This is a stunning 50 percent gain in life expectancy in just 50 years.

2. Reducing Infant Death

Dear to the hearts of all parents is the safety of their children. Parents who have experienced the joy of bringing a healthy baby into the world can imagine the agony that other parents suffer when they lose a baby at birth. The figure shows the heartening course of the rate of infant mortality in the United States. In 1900, early death was the fate of more than 1 birth in 10. In some areas of the country infant mortality was as high as 1 in 4. Today, only 1 in about 150 babies dies within the first year.

Although solidly reliable data for the United States are not available before 1915, according to Kenneth Hill, professor of public health at Johns Hopkins University, "In the now-developed countries of Europe and North America, the probability of dying before the first birthday has declined from, in many cases, 200 per thousand live births to less than 10 in the span of 100 years."

The infant mortality for black Americans (18 per 1,000 live births) is about double the rate for white Americans (9 per 1,000). That is the bad news.

The good news is that the rate of improvement in infant mortality for black Americans has been tremendous over the past century-even outpacing the improvement for whites. The black infant mortality rate is one-tenth what it was 100 years ago. This means that the gap between black and white infant mortality has closed steadily over the past century.

The decline in infant mortality and death rates during childhood is a result of vast improvements in education, nutrition, incomes, environmental conditions, and most of all modern health care.

Throughout most of history a child had about a 40-50 percent chance of dying before the age of 5. (The probabilities were 5 to 10 percentage points higher for girls and lower for boys.) The next figure shows the long-term plunge in infant death rates in the poorer countries of the world. In countries like India, Indonesia, and Mexico, a huge amount of progress has been recorded in just the past 20 years. According to The Economist, "Between 1980 and 1996 India almost halved its rate of child mortality. In 1980, 173 of every 1,000 Indian children died before the age of 5; in 1996 the figure was 85."

3. Fewer Mothers Die Giving Birth

These days Americans complain about drive-in child deliveries in which women are pushed in and out of the hospital within 24 hours. But childbirth is much safer for women today than in earlier times. Throughout the ages, it was not just the babies that failed to survive at birth. Historically, childbearing has been extraordinarily dangerous for women. In the 19th century as many as 1 in 100 women died during pregnancy. One hundred years ago, the maternal death rate was 100 times higher than it is today. In 1950 the maternal death rate was 10 times greater than it is today. By the 1980s only 1 in 10,000 women died giving birth.

Prior to the second half of the 20th century, safe procedures such as epidurals, Caesarean sections, and other medical technologies enhancing childbirth safety for the child and mother were not available. According to Elizabeth Whelan, executive director of the American Council on Science and Health, the plunge in maternal death rates is primarily a result of "increased prenatal care, new drugs to combat infection, and improved obstetric and prenatal practices."

The Centers for Disease Control reports that prenatal care is much more universally available today than ever before. The percentage of women who do not receive prenatal care before the third trimester of pregnancy has fallen by half-from 8 to 4 percent-in just the past 30 years.

4. Combating Death at Every Age

For our ancestors, human life was a constant struggle against death-particularly death at an early age. So it is good news indeed that the death rate (number of deaths per 1,000 population) has been falling steadily for at least the past 100 years. In 1900, the overall "crude death rate" was about 17 per 1,000 Americans; most recently, it is closer to 9 per 1,000 as the figure shows.

Impressive as this trend is, the crude death rate data understate the dramatic progress in conquering death in this century. The "age-adjusted death rate," for Americans fell by an astounding 53 percent from 1900 to 1950. Then it fell another 27 percent from 1950 to 1977 according to data compiled by the Centers for Disease Control.

Children between the ages of 1 and 14 are at least 10 times less likely to die than was true at the turn of the century and about one-third less likely to die today than was true in 1950.

For those in their preadult years, between the ages of 15 and 24, the death rate has plummeted sixfold since the turn of the century. Since 1950 death rates for this age group have declined by about one-third. For those in their working years, 25 to 64, death rates are half what they were at the turn of the century.

Amazingly, even for senior citizens, death rates have tumbled by nearly half despite increased worries of cancer, Alzheimer's, and other diseases associated with old age. According to Dr. Alan Fisher of the American Council on Science and Health, "Although methods of combating infectious diseases have made the most dramatic change in death rates, the contributions of 20th century medical knowledge to saving lives go further than that. If you've ever had ulcers, almost any kind of elective surgery such as an appendectomy, hypertension, diabetes, acute allergies, or problems during childbirth, modern medicine may well be responsible for your being alive today. In addition to life and death issues, current medical knowledge contributes to improving the quality of life. It does this through things as diverse as drugs for pain and physical therapy for rehabilitation."

5. Eradicating the Killer Diseases throughout the Ages

The United States and other rich countries have now experienced the almost complete disappearance of the major diseases that have killed billions throughout human history. The figure shows the decline in infectious diseases which started late in the 1800s. Success was so complete that young people today are not even aware of the scourges of typhoid fever, cholera, typhus, plague, smallpox, and the other terrifying killers of humankind resulting from the filth and unsanitary conditions that were commonplace in the past.

Before 1900 major killers included such infectious diseases as tuberculosis, smallpox, diphtheria, polio, influenza, and bronchitis. Just three infectious diseases-tuberculosis, pneumonia, and diarrhea-accounted for almost half of all deaths in 1900. Now few Americans die from these diseases, and many diseases have been completely eradicated due to a medley of modern medicines. The figure compares what we died of at the beginning of the century with what we die of today.

Since 1900 the childhood death rate from pneumonia and influenza has fallen by an astonishing 93 percent.

AIDS was a disease that exploded onto the public health scene in the mid-1980s. Although AIDS is a horrid epidemic in Africa, the incidence of AIDS in the United States hit its peak in 1992 when 85,000 Americans were diagnosed with the virus. By 1997 that number had dropped to about 30,000 cases. The decline in AIDS in the United States is a result of better education, behavioral changes, and a range of public health measures. Amazingly, the death rate from AIDS has fallen by half in just the past 3 years.

In the past decade, syphilis cases have dropped by more than 80 percent. Dr. Judith Wasserheit of the Center for Disease Control predicts that "if we can build on the success that we have had so far, we should be able to eliminate syphilis in the United States by 2005."

6. Vaccines and Drugs: The Miracle Cures

In 1918 an outbreak of a tragic influenza virus killed an estimated 3 million Americans and between 20 million and 100 million people worldwide. It targeted its lethal fury at young, healthy males mostly between the ages of 20 and 40. More Americans were killed by the 1918 influenza pandemic than were killed in combat during World War I. Could such a killer flu virus strike again? Perhaps. But as New York Times writer Gina Kolata, author of a recent book on the 1918 killer influenza, comfortingly assures us, "We now have antibiotics that can block the pneumonia-causing bacteria that overwhelmed us in 1918, new drugs to lessen the effect of influenza infections ... and vigilant surveillance to protect us from the most quotidian of infections."

The awful episode of the 1918 virus reminds us of how precarious life can be. It also helps us appreciate how many lives have been saved in this century by drugs. The greatest life-saving invention of the 20th century has been the vaccine. In fact, vaccines have been one of the greatest life savers in world history. Scientists generally attribute up to half the increase in life expectancy in this century to improved drugs, vaccines, and other medical treatment breakthroughs.

The figure shows the impact of vaccines on reducing four major diseases of the first half of the 20th century. Thanks to widespread vaccination, most of those diseases have nearly disappeared as health threats.

Diphtheria accounted for about 15 percent of all deaths in 1900. The figure below shows that the number of diphtheria cases fell sharply after the first vaccine was widely introduced in 1933 and then dropped almost out of existence after the DTP vaccine around 1950.

Whooping cough was also a major health problem in the first half of the century. But the number of cases fell almost tenfold from 1950 to 1960.

The number of polio cases fell from its peak in 1950-52 with more than 50,000 deaths per year down to about 5,000 in 1956 after the Salk vaccine was invented, down to 33 cases in 1970, and finally to zero cases in 1998.

7. Winning the Race for the Cancer Cure

Alas, we all have to die of something eventually. In this century, eradicating many of the most horrible and deadly infectious diseases-diseases that often afflicted children-has meant that the death rate from chronic and degenerative diseases associated with growing old-for example, heart disease and cancer-has risen accordingly. For example, 100 years ago cancer and heart disease were the cause of about one-quarter of all deaths. Today, they account for well over half of all deaths.

These days nearly everyone has a friend or family member who is battling cancer. This dreaded affliction seems to strike indiscriminately-against the young and the old, the strong and the weak. One American every minute of every day is a cancer casualty. But the good news is that we are making huge strides in preventing and treating cancer and heart disease as well.

The age-adjusted death rate from cancer is falling in the United States and much of the rest of the world. That is to say, for any particular age group-particularly the young-cancer is less threatening than ever before. This is true of almost every type of cancer, including leukemia-which is a killer of children. The most impressive strides have been made in reducing cancer deaths for women. The age-standardized death rate for women has fallen by more than 30 percent over the past 50 years.

One of the prevalent myths about cancer is that environmental factors-such as air pollution-have caused a cancer epidemic. The truth is that improvements in air and water quality over the past 30 years have contributed to the decline in cancer death rates.

At one time, to contract cancer was to receive a death warrant. Not so any more. We may not have a cure or any fail-safe prevention measure, but modern medical treatment has reduced death rates considerably in just the past generation. The figure summarizes the impressive gains in the span of just 30 years. For whites, the survival rate for cancer is up from 39 percent in 1960-63 to 62 percent by 1994. For blacks the probability of survival has roughly risen from one in four in the early 1960s to one in two today. Although good data do not exist before the early 1960s, it is a virtual certainty that cancer survival rates were much lower in the first half of the century.

8. Surviving Heart Disease

There is exceptionally good news regarding the fight against heart disease. The latest health research indicates that "Americans' heart attacks are becoming smaller and less lethal, probably as a result of healthier living habits and better medicines. Although heart attacks remain an exceedingly common and serious problem, the data suggest that people's chances of surviving them have increased dramatically."

Modern medical procedures and drugs have wondrously reduced the long-term fatality rate for heart disease. The death rate from heart attacks and heart failure has declined from 307 per 100,000 Americans in 1950 to 126 today.

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