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whpearson comments on Fundamentally Flawed, or Fast and Frugal? - Less Wrong
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That's a great discussion to have. I'd say the biggest changes are that a modern person interacts with a lot of other people and receives a lot of symbolic information. Other "major" changes, like increased availability of food or better infant healthcare, look to me minor by comparison. Not sure how to weigh this stuff, though.
We now also have computers.
I suspect the optimal evolved system in a modern environment (efficient and effective) is an idiot savant that can live long enough to spit out the source code for an AI guaranteed to increase the inclusive fitness of the genes of the host.
Genetic engineering and sperm/egg donation are other modern inventions I don't think we are all exploiting to increase our fitness optimally.