Growth is key to vaccines.

Easterlin rejects the idea that economic growth has been largely responsible for the health transition, and he tests a version of this hypothesis, the "McKeown hypothesis," which claims that the causal factor generating the health transition is specifically better nutrition from greater wealth and income," Easterlin argues that if this hypothesis holds, then we should observe a tight connection between rising levels of income and rising life expectancy. There should be a short time lag between them, and the time lag should be approximately the same. But the data do not show this, rather they show that in England and Wales it took several decades for life expectancy gains to be made, while in Sweden, for example, the gains came very quickly with the rising income that indicated the advent of capitalism in that country. Does this show what Easterlin wants to show, namely, that economic growth is not causally responsible for the historical health transition has now been accomplished in much of the world? I think not. There are other relevant differences between the cases. England was highly urbanized, which created conditions for increased spread of infectious diseases, as Easterlin recognizes. But this means that there was a higher bar for the wealth effect to overcome, it does not mean that there was no wealth effect. Thus, I think his rejection of the McKeown hypothesis is premature. Furthermore, the fact that Sweden's transition to capitalism came later gave it an advantage in the sense that it could learn from techniques adopted in England to improve health. Easterlin's alternative hypothesis is that the introduction of smallpox vaccines accounted for the progress in life expectancy in both cases. But there are two things to note about this alternative that are relevant here. First, even if this is the main cause of the health transition, the wide availability of smallpox vaccines - their production and distribution, communication about their use and effectiveness, and the responsiveness of public health agents to the desire of citizens for them - must at least in part be due to the conditions created by capitalism, including greater wealth and income, higher levels of education, and increasing legal and public infrastructure According to Jonathan Tucker, "a key breakthrough in the control smallpox in industrialized countries was the invention of the Icebox, which made it possible to refrigerate smallpox vaccine and thereby preserve its potency for long periods."4' Second, citing smallpox vaccines alone ignores another major contributor to female life expectancy (the statistic s he uses in his argument): falling fertility rates. Capitalism, 1 will argue, played a major role in encouraging and facilitating lower fertility rates, which in turn increased maternal and infant survival rates.