James C Riley, Rising life expectancy: a global history , Cambridge University Press, 2001, pp. xii, 243, £30.00, US$49.95 (0-521-80245-8), £11.95, US$16.95 (paperback 0-521-00281-8).

Human mortality decline has resulted in massive improvements to life chances in all parts of the globe. In the two centuries preceding the end of the second millennium, average life expectancy more than doubled, from below thirty years in 1800 to nearly sixty-seven years in 2000. Further increases are anticipated. The essence of this highly readable book is to lay down the probable reasons for this remarkable transformation. As such, James Riley demarcates six broad areas for the reader's consideration: public health; medicine; wealth, income and economic development; nutrition and diet; household and individual behaviour; and literacy and education. The lucidity and clarity that Riley has brought to bear on a topic—namely the routes to low mortality—that continues to excite intense debate in both historical and medical literatures, is commendable. The footnotes and guides to further reading that appear at the end of each chapter are pleasingly eclectic. It is perhaps unavoidable, however, that writing a history of synthesis sometimes involves summarizing complex issues in an overly simplistic way. On the one hand, the section on the ambiguous and still-contentious role of maternal education in child survival is frustratingly brief. On the other, the influence of germ theory in public health intervention, in the development of biomedicine, and on individual behaviours is dissipated sketchily through as many as four separate chapters of the book. The demands of brevity can, of course, work favourably in the hands of a capable author, since crucial points need to be more tellingly made. The pithy observations that Riley makes at the end of each chapter testify to his talent in this respect and underline that in absolutely no way should the criticisms outlined above prevent the book from becoming a standard introductory text in undergraduate history courses concerned with the evolution of human health. It is also probable that Riley's contribution will find for itself a profitable market in the field of global history. One of the book's strengths is the way in which it pays far more than lip service to international comparisons. Riley's thematic organization enables him to make some prescient contrasts, such as the divergent ways in which enteric ailments were largely brought under control in industrializing Britain in the nineteenth century and in Costa Rica and China during the later twentieth. Readers in some parts of the developing world may be struck by the close comparison of overcrowded domestic conditions in slum dwellings in Nigeria and India in the present and the very recent past, with those in nineteenth-century Europe. Such wide-ranging examples, both in terms of time period and geographic location, are commonplace throughout the book. They lead to Riley's main conclusion that no one nation's—or even sub-national region's—experience of improving life expectancy was or is replicated in another. National routes to low mortality inevitably vary due to choices made from the suite of six “tactics” (Riley's word, p. 56) available in relation to public health intervention, medical care and the emphases placed on wealth generation, education, nutrition and behaviours. But is an international comparative framework enough to make Rising life expectancy a truly global history? If Riley's panoptic use of evidential material were the criterion, then for those of us who scratch around in the dark warrens of local and micro-histories, his approach is a refreshing and necessary counterpoint. But this should not be the sole basis for judgement. A more fundamental question would be to ask whether an account of improving global life expectancy that places the “health transition” at its intellectual core is any more or less satisfying as a world-view than demographic and epidemiologic transition theories, both of which are deeply Euro- and North American-centric in their basic assumptions and empirical grounding. As Riley explains, “the key factor in the health transition is not disease but the actions that diminish it, reducing mortality or morbidity. Those can be divided into four categories: avoidance, prevention, treatment, and management” (p. 26). Obvious though the advantages may seem that this definition holds over epidemiologic transition theory, the idea of health transition is fairly recent, achieving widespread acknowledgement only in the mid-1990s. But from a global historical perspective, surely it remains problematic as a unifying schema. At the risk of applying a different gloss on the “global” to that which Riley intended, two observations make this point. First, he notes that the gap in life expectancy between rich and poor countries has been shrinking, largely due to mortality reductions in countries that “came late to the health transition” (p. 40). “Late” compared to which countries, in what time period, and when? Second, in the chapter on the role of medicine, Riley sees the need to distinguish practices of traditional and modern healing from one another (p. 89). “Traditional” and “modern” for whom, when? And who decides what is “traditional” and what is “modern” anyway?