I wonder at which decade of life the improvements happened, though. Obviously most child mortality went away, as well as women dying when giving birth. I’m guessing there have also been a lot of improvements in the 50s and 60s where way more people used to die of now treatable heart conditions. Earlier in life people probably benefit from fewer traffic deaths and in older age from better cancer treatment. Or maybe I’m wrong about all of this.
I wonder about antibiotics. Yes, people died horrible deaths from infections, but how many did? As far as I know, I’ve never had any antibiotics because I never needed them. My brother would probably have died as a kid from a ruptured appendix without them, though.
Much of the difference in countries comes from different ethnic groups. For example the US has the same overall life expectancy as Costa Rica, but Hispanics in the US have a life expectancy that is 3.5 years longer than average.
This makes me think most of life expectancy is genetic and not due to a country’s medical system. For example, black americans have a life expectancy that is 11 years less than Asian americans even though they share the same medical system.
They “share the same medical system” only in the sense they live in the same country under the same laws & regs.
The US “system” consists of several levels that depend entirely on your ability to pay for care. My brother is working poor and uninsured. He gets exactly zero care. I’m upper-middle/lower-upper income and have top notch soon-to-be-Cadillac-taxed insurance. I have unlimited high quality care with excellent customer service at negligible OOP cost. Same system, two utterly different realities.
Until you correct the racial statistics for socioeconomic class you have a very big noise overwhelming your signal.
You can use some charts here (2a and b) to parse it out some.
Life expectancy at birth had a dramatic and fairly linear increase from 1900 to 1960; life expectancy at 65 fairly linear from 1940 on for females and 1970 for males.
The initial big drivers for life expectancy at birth were vaccinations and improved sanitation both resulting in many fewer childhood deaths. Antibiotics as well but probably less of an impact than the first two. Healthier mothers-to-be also impacted both deaths of babies and young adult women. Those however did not much impact life expectancy at 65 numbers. Less malnutrition was another big driver (transitioning into recent decades’ issues of “over-nutrition”)
A downward pressure on life expectancy that straddled both overall and the at 65 curves was the dramatic increase in smoking with dramatic increases beginning in the 30s and continuing to peaks in the 60s before beginning the drop back down.
Impacted upwards in the same straddle were improved motor vehicle safety and then the decline in smoking which dramatically decreases heart disease, stroke, and cancer deaths.
Further increases are due to improved management of chronic disease states … managing elevated cholesterol and diabetes in particular. And interventions for acute diseases.
puddlegum there may be genetic components but the SES, the average lifestyle, and the access and interface with the healthcare system are all very different for Asian and Black Americans.
Slightly less than 20% of UK residents smoke. You just notice them more. Their smoking rate is only about 3% more than the USA as a whole, altho nearly twice California.
Obesity rate going up is mostly caused by the Diet industry making changes to the definition of “obese” so as to sell more diet products. BMI is pretty much worthless as a definition of how unhealthy you are.
iljitsch, a sort of general rule to use about in which decades of life people are less likely to die now than a century and a half ago is that younger people are much less likely to die now, while older people are only somewhat less likely to die. So there are much less deaths at birth and shortly after birth than there used to be. On the other hand, if you reach 110 today, you have an average amount of life left of something like nine months. I suspect that’s not too different from how it was 150 years ago.
It’s true that young people have very low mortality rates these days (although the ascent of text messaging in traffic may reverse that trend), but what about all the medicine that keeps middle aged people alive? Or maybe that just compensates for the fact that we didn’t really used to have diabetes type 2, coronary heart disease and many types of cancer until a century ago…
It’s certainly true that once people reached middle age they had a good shot at living into their 70s throughout recorded history. I guess a factor in that is that most people with some kind of health issue wouldn’t survive into middle age in the first place.
Yes. It is true that for most of history (until the 19th and 20th centuries) the average life expectancy was around 35 years. This was due to the enormously high infant mortality rate that has been largely eliminated through advances in obstetric medicine. Read some history books - there are ample examples of medieval and ancient people who lived to 60 or 70 years. In fact, if you survived to age 20 (no mean feat in those days of no antibiotics and no child labor laws), you were, barring a war or accident, very likely to make it to 60. My great-great-great grandfather is buried out on the prairie with most of his children - only two lived to adulthood, one of them being my great-great-grandfather. G-g-g-grandpa made it to 75.
Right. A large percentage of people with chronic health problems or disabilities would die in childhood in those days. If you were born with, say, cerebral palsy in 1530, there was no treatment - you would be left to the mercy of God and probably die of your condition before you reached your teen years. Those people who did live to adulthood were generally the ones with excellent heath, and that health propelled them into their 60’s and beyond, usually.
This is also why people in those days had so many children - if you wanted to have two or three children to take care of you in your old age, you had to give birth to five or seven children or maybe more, knowing that half would die. It was life.
Type 2 diabetes has been around a long long time. Metformin came from a herbal treatment of urine flowing through (sweet type) i.e. diabetes mellitus, that was around from before the Middle Ages.
But yes the numbers have increased with the increase in obesity rates and of people living longer.
Likewise many cancers are best considered as a consequence of the aging process. Some are more preventable with identifiable and avoidable triggers that significantly increase their risks - lung cancer and smoking; liver cancer and early life Hepatitis B infection (will decrease with routine HepB vaccination); cervical cancer and HPV infection (also on course to decrease).
Childhood malnutrition did have life long impacts as well, lopping off some as they got older from its longer term consequences.
Life expectancy having reached 65 has not gone up much for females in the last three decades, males have improved more but a 65 year old male is still more likely die before a 65 year old female.
Life expectancy by race does not follow SES that well in the US. For example Hispanics in the US have a lower median income than blacks and are more likely to be uninsured but have lifespans that are on average seven years longer.
A variety of risk factors, lifestyle correlations, and interactions with the healthcare system (the last inclusive of what gets called "institutional racism) do not strictly follow SES.
Again, it is not impossible for genetics to play a role, but the complexities include many other factors. For example rates of smoking (18.3% of Black Americans smoke and only 12.1% of Hispanic Americans do - the only group that is lower are Asian Americans at 9.6%); the rate of gun deaths (18.5/100K for Blacks and 7.1/100K for Hispanics); and what is known as “the healthy immigrant effect” in which the process of immigration, with its various barriers, selects for a group that is on average healthier.
That doesn’t mean that there were no improvements, though. All the people that used to die before age 65 but are now kept alive through interventions such as cancer treatments and angioplasty now die at some point beyond their 65th birthday, and it’s safe to assume that for most of them, this will happen below the average set by the previous 65+ group. So if the average is stable, this probably means that those who are healthy at 65 today live longer than someone in a similar position several decades ago.
Also note that the number of centarians has been rising quickly in recent decades. So some people are getting older…
Thanks for everyone’s insights. I did forget about the “longer lifespan, but not a health longer lifespan.” The homicide number in U.S. reminds me of a few years ago when I heard about the number cause of death for pregnant women in U.S. was murder.
We 'll just have alternate ways to die over the centuries:
I was reading Thomas Jefferson’s bio awhile back, and so little has been said about his wife, (I can’t even recall her name, Elizabeth?). When she married Thomas, she was already a widow with one dead son baby, at age 21. I read that there were guesses at what caused her death…that having her fifth child killed her as she may have had gestational diabetes that was never treated.
In my medical sociology class, our professor once asked us what was the number one reason why people lived longer in the last 150yrs and dying less from disease, we had guessed vaccines and medicine, but he said it was Hygeine. That prevented cholera and such and now we have other leading causes of death. In one BBC documentary about the Victorian age and into Edwardian age, one big cause of death was falls. (Did Pierre Curie die this way?) and a historian explained how there was no code to follow in building homes and mansions , and oftentimes servants fell to their death from uneven staircases.
The homicide rate has dropped a great deal in the past twenty-some years in the U.S. It peaked in 1992 and is now about half what it was in that year. The homicide rate is about what it was in the early 1960’s now. Yes, I know that there was an increase during the first half of this year, but compared to the drop of the past twenty-some years, it wasn’t that much and it’s too soon to tell if this year is a blip or a trend.
One little possible surpring bit about overweight, obesity, and diabetes … those diagnosed with diabetes and treated with metformin have a lower mortality ratethan matched controls without diabetes.
Metformin may have benefits beyond its blood glucose control impact on a variety of chronic conditions thought to be diseases of aging.
I’d still pick avoiding diabetes with healthy diet and exercise than diabetes and metformin … by far. But given someone who is not exercising and not eating so healthily, getting to the point of being on metformin seems possibly better than not crossing the line.