Wellbeing is widely seen as a multi-dimensional phenomenon affected not only by material goods, but also health, education, agency and freedom. In order to measure the evolution of this multi-faceted process across populations, about thirty years ago the United Nations Development Programme focused on a related idea: Human development, ‘a process of enlarging people’s choices’. This became the basis of their widely-used Human Development Index (HDI).
In my research, I have constructed a new Augmented Human Development Index (AHDI) that goes beyond the original three dimensions considered by the HDI (health, education and material living standards) to also incorporate political and civil freedom. This project has resulted in a comprehensive database that tracks Augmented Human Development (AHD) for up to 162 countries over one and a half centuries (see here)
My results show that augmented human development (AHD) grew substantially around the world since 1870, reaching in 2015 a level 5.3-fold that of 1870. In other words, the ability of individuals to choose the lives they want to live has significantly expanded during this time period. However, there is significant room for improvement in some parts of the world, because there are still significant differences in AHD across countries nowadays (see Figure 1).
Figure 1. Augmented Human Development in the World in 2015
These differences in AHD are not new. I study their dynamics by looking at relative inequality (cross-country percentage differences) and absolute inequality (cross-country absolute differences) in AHD. My findings show that relative inequality in AHD increased initially up to World War I, and then it experienced a steady long-run decline from the late 1920s. This has resulted in a major process of relative convergence of world AHD during the 20th century. Absolute AHD differences between countries, however, rose up to the mid-twentieth century, and only fell from 1960 onwards. A closer look shows that middle and low human development countries achieved larger relative gains in the long run, but the top 10 per cent of countries obtained the largest absolute gains.
These inequality dynamics were the consequence of the uneven distribution of gains in augmented human development. The absolute gap between the most advanced regions (Western Europe and its Offshoots, plus Japan, OECD for short) and the rest of the world deepened over time, although it fell in relative terms from the late 1920s.
An apparent development puzzle emerges: progress in economic growth and human development do not match. During the backlash against economic globalization (1914-1950), when real per capita GDP growth slowed down as world commodity and factor markets disintegrated, AHD experienced major gains across the board. Conversely, in the post-1950 era, AHD advanced significantly less rapidly (see Figure 2). Why did economic growth not result in human prosperity?
Figure 2. Augmented Human Development* and Real Per Capita GDP Growth (%) * excluding the income dimension
Exploring the specific drivers of AHD over the long run may explain why its trends were uncorrelated with those of GDP per capita. In this process, Life expectancy stands out as the main contributor to AHD long-run progress, although its greatest contribution was concentrated over 1914-1970. This implies that health developments have been a major engine of human flourishing during most of the 20th century. In addition, education was a steady contributor to AHD over the entire time span considered and political and civil freedoms added substantially throughout the twentieth century, especially in its last two decades.
Figure 3. Drivers of Augmented Human Development in the World, 1870-2015 (%)
What explains the timing and depth of life expectancy contributions to human development? It is commonly assumed that economic progress largely explains this, as higher levels of income per capita facilitate the allocation of more resources to social services that improve people’s health and education. However, over the last one hundred years, gains in longevity and education have taken place across the board, including countries where social spending has hardly expanded and growth in income has faltered. Although economic growth results in improving nutrition -which strengthen the immune system and reduce morbidity- and increases in the provision of public services, improvements in medical knowledge have been the main source of the sustained increase in life expectancy. The major improvement in longevity over 1920-1970 originated in the discovery and diffusion of the germ theory of disease that led to the epidemiological transition in which infectious disease gave way to chronic disease as the main cause of death.
It is also assumed that global health improvements only occurred after World War II, when new drugs from the West diffused across the rest of the world. However, in developing countries, life expectancy provided half the gains in human development between 1914 and 1950, when a large proportion of the Rest was still under colonial rule and the new drugs were largely unaffordable for the population. This suggests that the epidemiological transition spread beyond advanced countries since the 1920s. In fact, the germ theory of disease led to the diffusion of preventive methods that lower disease transmission. The result was to reduce mortality throughout the life course, but especially infant mortality and maternal death.
Although a second episode in which longevity, along with education, made a massive contribution to human development in the 1960s, by 1970, the diffusion of the epidemiological transition was largely exhausted in the Rest. This helps to explain the weakened contribution of life expectancy to improving human development after 1970. The renewed contribution of life expectancy to human development since 1990, largely restricted to advanced countries, is associated with a second health transition which has led to mortality falling among the elderly as a result of better treatment of respiratory and cardiovascular disease and vision problems, helped by better health and nutrition in their childhood. Its diffusion has resulted in longer and healthier life years. The fact that the Rest has not participated so far in the second health transition, along with the AIDS-HIV pandemic in Sub Saharan Africa and the collapse of socialism in large areas of the world, help explain life expectancy’s negative contribution to the Rest’s catch up to the OECD during 1990-2010. A long-run perspective on the topic shows that while these inequalities remain, there is substantial potential for improving the lives of millions and making the world a more equal place in which everyone can lead the lives they want to live.
Full professor (Carlos III University of Madrid)
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