Delivered. In just under three centuries, life expectancy at birth has almost tripled. Huge inequalities persist, between the regions of the world and within each country, but the fact is there: on average, the king index of our well-being, the indisputable metric of human progress, has increased in proportions. considerable over the past decades. This extraordinary success, however, as such, generated little thought; there are many histories of medicine, but very few of human health.
With her Great Extension, the doctor and epidemiologist Jean-David Zeitoun fills this gap and shows that the improvement of the health status of our species is neither an emerging property of only medical progress, nor a mechanical consequence of economic development. This is the full contribution of this dense and brilliantly conducted essay: to tell, through history, the diversity of the underlying causes of the rise in life expectancy, and to show that behind this curve which seems climb in such a monotonous manner since the end of the Second World War, hide a myriad of determinants that relate as much to medicine as to the great technical and industrial revolutions, economic transitions, wealth and social inequalities, the impact marketing on collective behavior, or the state of the environment.
Without neglecting the contributions of remarkable personalities – from the British doctor Edward Jenner (1749-1823), the inventor of the vaccine, the ancestor of our vaccines, to the economists Anne Case and Angus Deaton, theorists of the “deaths of despair” of the ‘XXI Americae century -, whose scientific portraits form one of the frameworks of the book.
Very high infant mortality
His first observation is simple: it is that of a relative stagnation of life expectancy, from the Neolithic to the beginning of the 18th century.e century, at levels of great mediocrity. Probably around 25 to 30 years old. Jean-David Zeitoun warns against quick interpretations. This does not mean that most women and men died around this age, but rather that infant mortality was very high. “It is probable that until the XVIIIe at least half of the children died before the age of ten ”, he writes. Undernutrition, violence, infections: it was this triptych that took the most lives.
One of the first notable health events is, in the Enlightenment, the rise of “variolation”, this rudimentary technique of immunization against smallpox which will evolve into vaccine. With the Enlightenment, the taste for scientific exploration and the acquisition of knowledge is put at the service of health. Vaccination against smallpox will have, in a few decades, massive effects on the reduction of mortality.
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