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Introduction to Modern Economic Growth estimates and argues that differences in health capital emerge as an important factor in accounting for cross-country differences in income levels The idea that part of the low productivity of less-developed nations is due to the unhealthy state of their workforces has obvious appeal The micro evidence and the work by David Weil shows that it has some empirical validity as well But does it imply that geographic factors are an important fundamental cause of economic growth? Not necessarily As already mentioned above, the burden of disease is endogenous Today’s unhealthy countries are unhealthy precisely because they are poor and are unable to invest in health care, clean water and other health-improving technologies After all, much of Europe was very unhealthy and suffering from low life expectancy only 200 years ago This changed with economic growth In this sense, even if “health capital” is a useful concept and does contribute to accounting for cross-country income differences, it may itself be a proximate cause, affected by other factors, such as institutions or culture 4.6 4.4 4.2 3.8 3.6 3.4 3.2 1930 1940 1950 Initially Rich 1960 1970 Initially Middle Income 1980 1990 2000 Initially Poor Figure 4.15 Evolution of life expectancy at birth among initiallypoor, initially-middle-income and initially-rich countries, 1940-2000 A recent paper by Acemoglu and Johnson (2006) directly investigates the impact of changes in disease burdens on economic development They exploit the 203