December 23, 2014 6:48 pm
Let us enjoy the greatest human escape of all
Martin Wolf
More prosperity is not necessary nor sufficient for improved health. It just makes it easier
The highest life expectancy recorded for women anywhere in the world has risen by a year every four years since 1840. This inexorable advance in longevity is, arguably, the most important of all the changes to human life in the past two centuries.
These gains in health are also widely shared: “India today has a higher life expectancy than Scotland in 1945 — in spite of a per-capita income that Britain had achieved as early as 1860.”
This remark comes from a wonderful book, The Great Escape: Health, Wealth, and the Origins of Inequality , by Princeton University’s Angus Deaton, published last year, which documents the revolution in both health and wealth since the early 19th century. Of the two, the former is the more important. Who would not give up many material comforts if, in return, they could avoid the agony of watching their children die or enjoy the company of their loved ones in old age?
This remark comes from a wonderful book, The Great Escape: Health, Wealth, and the Origins of Inequality , by Princeton University’s Angus Deaton, published last year, which documents the revolution in both health and wealth since the early 19th century. Of the two, the former is the more important. Who would not give up many material comforts if, in return, they could avoid the agony of watching their children die or enjoy the company of their loved ones in old age?
No blessing is unmixed. Prolonged survival “sans teeth, sans eyes, sans taste, sans everything” is to be neither envied nor desired. Yet the revolution in health is still a blessing. As Professor Deaton notes: “Of all the things that make life worth living, extra years of life are surely among the most precious.” Someone whose standard of living is twice as high and expects to live twice as long as someone else could even be deemed to be four times better off.
Start with mortality rates (deaths per thousands) over time of three of today’s high-income countries: Sweden in 1751; the US in 1933; and the Netherlands and the US in 2000 (see chart).
Back in 1751 the mortality rate of Swedish newborns was more than 160 per thousand people.
It was more than 40 per thousand in the US in 1933. By 2000 it was below 10 per thousand. At subsequent ages mortality rates have become consistently lower over time, with the lowest rates of all for children aged about 10. Today we see a rise of mortality rates in the late teens, largely because of the riskier behaviour of young men. After a plateau in the late 20s and early 30s, death rates rise, but they do not reach 10 per thousand before age 60. US mortality rates are higher than those in the Netherlands, except for the over 80s. That is where the US concentrates its resources.
Back in 1850 life expectancy was about age 40 in England and Wales. Today it is close to 80. In the case of Italy it has risen from 30 in 1875 to above the English level. The chart also shows the devastating effects of the Spanish flu epidemic of 1918. This is explained by how life expectancy is computed: the assumption is that the risks of dying at a particular age are produced by the ages of death of the population in a specific year. In 1918 a large proportion of young people died in the epidemic.
This reduced life expectancy drastically. But those born in 1918 had far longer lives than these figures suggest. Similarly, a small proportion of the English and Welsh population actually died at 40 in 1850. Instead, a great many died aged as babies and many lived to be more than 60.
Forty was merely the average age of death. Finally, notes Prof Deaton: “Saving the lives of children has a bigger effect on life expectancy than saving the lives of the elderly.” Thus, as death “ages”, the rise in life expectancy slows.
The health revolution has spread worldwide since the middle of the 20th century — dramatically so in east Asia; least so, alas, in sub-Saharan Africa partly because of HIV/Aids. A big element has been the collapse in child mortality. According to the Gapminder website, mortality among Indian children under five fell from 267 per thousand in 1950 to 56 in 2012.
Over the same period it fell from 317 to 14 in China. These improvements occurred at much lower income levels than was the case in today’s high-income countries. This is partly because of improved knowledge (oral rehydration, for example), partly because of medical technology (vaccination, for example) and partly because of public services (clean water and sanitation, for example).
Over the same period it fell from 317 to 14 in China. These improvements occurred at much lower income levels than was the case in today’s high-income countries. This is partly because of improved knowledge (oral rehydration, for example), partly because of medical technology (vaccination, for example) and partly because of public services (clean water and sanitation, for example).
The health revolution is not just a good in itself. It has beneficial consequences, the most important of which is the transformation of women’s lives. As child mortality tumbles, so does fertility: fewer births are needed to achieve a given family size. This is irrespective of religion: in Muslim Iran, for example, the number of children per woman fell from 6.5 in 1980 to 1.9 in 2012; similarly, in Catholic Brazil it fell from 6.2 in 1960 to 1.8 in 2012. As women live longer and have fewer children, they can invest more in each child and pursue their own careers. Thus the health revolution underpins another of the revolutions of our era: the change in the role of women.
What has driven the improvements in health, particularly among the middle aged? A decline in smoking is a factor. Improved treatment for heart disease is another. Even cancer is succumbing to treatment. Increasingly, in high-income countries, the remaining diseases are those of old age, including dementia. But in most developing countries the old afflictions linger, including poor sanitation, contaminated water and malaria.
Yet for all that remains to be done, and all the inequality of health services across the globe, it is important to appreciate the great and increasingly widely shared improvement in health. An increasing proportion of humanity has a good chance of living healthily into what has traditionally been viewed as old age. A rising proportion of children is reaching maturity. We cannot escape death. But we do keep out of its grasp for ever longer. That is to be celebrated.
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