The 2007 Nicholson-Freeman movie, “Bucket List,” asked the question, What would you do new and differently if you had a short time to live? Let’s flip that question over. What would you do new and differently if you realized that you were going to live much longer than you thought? That is the question that many Americans faced in the early part of the twentieth century when it became clear that people were indeed living longer than had been expected since “time immemorial.” And about a generation earlier, Americans had realized that children were surviving infancy at greater rates than had been true since “time immemorial.” That raised its own questions, too.
Helen Zoe Veit in a recent issue of the Journal of Social History describes one sort of reaction that American opinion-makers – doctors, journalists, health officials, and the like – had to these new extensions of life: They urged Americans to take personal responsibility for their health. Now that they could live for a long time, it was Americans’ duty to control their health by, for example, eating well and especially, said the doctors and insurance companies, by getting regular doctor check-ups.
This personal responsibility mantra is an ironic response to greater longevity, given that what had extended Americans’ lifetimes was the exercise of collective responsibility. Still, the prospects of longer, safer lives did, it seems, affect Americans’ sense of personal control over their lives.
The graphs below show how much Americans’ lifetimes expanded over the last 150 years or so. The left-hand graph shows how long, on average, a baby born in each year could be expected to live. The anticipated life span roughly doubled: under 40 years for babies born in 1850 to about 75 years for the birth class of 2000. The greatest change occurred in the late 19th and early 20th centuries. The basic reason more children survived was public investment in clean water systems, sewers and sewage treatment, and disease control such as mosquito abatement, and government regulation, such as milk inspections. These programs severely reduced the incidence of intestinal diseases that killed so many infants. Technological developments, such as refrigeration and agricultural efficiencies, helped as well by improving American nutrition and driving the cost of healthy food down.
The right-hand graph shows average life spans of Americans who had made it through childhood and reached the age of 20. A 20-year-old in 1850 would, on average, live to 60; a 20-year-old today could plan to live into the late 70s – and some demographers think this is a major underestimate, that they will live much longer. The major advance in adults’ survival occurred later than the advance in children’s survival, around the mid-20th century. Adults were helped by the same developments that saved children’s lives and in addition by major reductions in accidents and, eventually, the development of medical treatments for infections and for chronic ailments of like heart disease and cancer.
The irony is that Americans lived longer largely because of collective, civic programs – from sewer construction and agricultural extension to NIH medical research – and yet, as Veit describes it, the message that many American opinion-leaders pumped out was that individual responsibility was critical. Some changes in personal habits no doubt helped extend lives – mothers became more careful about infant care, adults washed more often with soap, for example – but they were a minor part of the story. Indeed, some personal decisions in these same years were undermining adult health: Between 1920 and 1960, Americans’ per capita consumption of cigarettes rose thirty-six fold (by 2000 it had dropped to about half of the 1960 level; source).
It seems historically illogical to emphasize individual responsibility after realizing how institutional changes extended American life spans, but there is a psychological connection here that does make sense.
When life is highly insecure and even seems random, when so many people get struck down at any time and not just in their old age, it is hard to have a sense of personal control. It is hard to feel that you can manage the future and that you should plan for the long run. Any day can bring disaster. But if life starts to look safer and more predictable, taking initiative becomes a more plausible strategy.
Americans responded to the dramatic drop in infant deaths 100 to 150 years ago by doing more family planning, having fewer children, and investing more time, money, and emotion in each child – exercising more control rather than leaving their families in God’s or Fate’s hands. It is likely that they also felt increasingly anxious about how well they were managing their children’s health and development (see, e.g., here, here, and here).
American adults seemed to respond to the substantial extension of adult life 50 to 100 years ago (and growing economic security, too) by planning more for their futures – getting more education, investing in long-term careers, taking on debt, even planning for retirement.
So, it does make psychological sense to argue that, because new circumstances made Americans more secure, they responded by accepting more individual responsibility for that security.