The modern secular decline in mortality in Western Europe did not begin until the 1780s and the first wave of improvement was over by 1840. The elimination of famines and of crisis mortality played only a secondary role during the first wave of the decline and virtually none thereafter. Reductions in chronic malnutrition Were much more important and may have accounted for most of the improvement in life expectation before 1875. Chronic malnutrition were much more important and may have accounted for most of the improvement in life expectation before 1875. Chronic malnutrition could not have been eliminated merely by more humane national policies, but required major advances in productive technology. Although there Were some improvements in the health, nutritional status, and longevity of the lower classes in England and France between 1830 and the end of the nineteenth century, these advances were modest and unstable, and included some reversals. An even larger reversal occurred among the lower classes in the United States. Although the technological progress, industrialization, and urbanization of the nineteenth century laid the basis for a remarkable advance in health and nutritional status during the first half of the twentieth century their effects on the conditions of life of the lower classes were mixed at least until the 1870s or 1880s. The great gains of the lower classes were concentrated in the sixty-five years between 1890 and 1955. Improvement in nutrition and health may account for as much as 30 percent of the growth in conventionally measured per capita income between 1790 and 1980 in Western Europe, but for a much smaller proportion in the United States.