Food and Medical Care in 20th-Century America

There is an important and continuing debate occurring in the United States regarding health care, so it seems like an appropriate subject for review in this week’s Historical Perspective. At the same time, we review another fundamental necessity of life; namely, food. The source material for this historical perspective is “The State of Humanity,” edited by Julian Simon; more specifically, chapter 14 by Stanley Lebergott: “Trends in the U.S. Standard of Living.”

Between 1900 and 1929, spending for doctors, dentists and other health care practitioners nearly doubled in real dollars. Drug spending increased four-fold, while spending on hospitals increased ten-fold.

But the real improvements in American health care began after World War II. In the 19th century it was probably the case that many more people were injured than aided by drug treatments, which were in their infancy. (Any reader of Victorian era novels will be familiar with the “bleeding” medical techniques of the time.)

However, it was only after World War II ended that the miracle drugs such as penicillin and sulfanimides began to reach civilian markets. Only at this time, within the lifetimes of ourselves or our parents, did the thousands of years of human suffering and death from influenza, tuberculosis, measles and other ailments begin to find an effective opponent. The U.S. death rate from infectious disease fell to less than a tenth of what it was in 1900. In addition to the safety provided by new drugs, increased spending for doctors and hospitals and new technology resulted in faster diagnoses, less pain, shorter hospital stays, and longer lives for the sick.

Food and diet followed the same course of improvement as health care in America. Although famine still haunts other parts of the world, especially Africa, it has not been a factor in America, Europe, or Canada during the last two centuries. Even in the worst depression year, 1932, nutrition in the U.S. was as good as in either 1929 or the 1970s.

Food is also more affordable now. Although modern consumers are spending twice as much, in real dollars, for food, as they did in 1900, the percentage of an average consumer’s income spent for food has declined. In 1900, the average consumer spent about a third of his income for food. By 1929, this percentage had dropped to one quarter, and by 1987 to 18 percent.

Not only did food eat up less of the consumer’s budget, it also took less time to make. In 1900 a typical housewife spent many hours washing, peeling, coring, cutting, boiling, and blanching vegetables and fruit. This work was dramatically reduced by various factors, such as the increase in canning as well as the increased tendency for food to be eaten or prepared outside the home — at restaurants, factory cafeterias and school lunch rooms.

Not only has food become relatively less expensive and less time-consuming to prepare, but it has also become much healthier. Consumption of potatoes, flour, cereals, and fatty dairy products have all declined dramatically, and have been replaced by more varied food.

There is less consumption of foods such as salt pork, salt beef, lard, and molasses, the consumption of which had been driven by the low price of these foods. Instead, Americans consumed 300 percent more poultry and more luxuries, such as a 1,350 percent increase in consumption of ice cream. In the last few decades the consumption of red meat and coffee has decreased, while the consumption of orange juice, yogurt, and sugar substitutes has increased.

The reality of our age is better health care and a healthier diet. When combined with the other improvements we have discussed in previous Historical Perspectives, it becomes clear that Americans have never before had as good a chance of staying healthy as they do today.