The origins of health inequality: An early elite mortality transition, 1650-1825

Sheila Johansson (Cambridge University, Royaume-Uni)

The health transition is conventionally measured using life expectancy trends. In terms of rising (and unreversed) life expectancy levels in adulthood, Europe's royal families began a health transition in the l600s; their life expectancy at birth levels began to rise in the early l700s as infant mortality finally fell. The English royal family had a particularly rapid health transition. Comparing individuals born in the 1600s to those born in the l700s, royal life expectancy at birth rose more than 20 years. The European Continental and English royal health transition is a more extreme case of the general elite mortality transition which began in the l600s and early l700s, between fifty and one hundred years before signs of a health transition can be detected at the national level.

This paper explores the origins of the elite mortality transition, and explains it in medical terms, in particular to a few innovations that brought several leading causes of death/morbidity under greater control. The diseases discussed include severe dysentery, malaria, land scurvy and smallpox. Declining maternal mortality is also discussed from the standpoint of medical (surgical) innovations.