In the latest issue of the British Medical Journal, Jessica Ho and Arun Hendi chart recent trends in life expectancy in 18 rich countries. The authors rightly note that ‘life expectancy is a key summary measure of the health and wellbeing of a population’. Not surprisingly, the UNDP’s iconic ‘human development index’ (HDI) incorporates life expectancy as one of its core components alongside per capita income and education.
While ‘monumental improvements in life expectancy have been the predominant trend for high income, developed countries over the course of the 20th and 21st centuries’, recent changes have been mixed and in some cases, most notably the United States, the evidence on the evolution of life expectancy has been quite disturbing. Ho and Hendi show that in 12 out of 18 countries, life expectancy declined moderately in 2014-2015, although this has been offset by robust gains. The exceptions have been the United Kingdom and the United States which appear to be ‘experiencing stagnating or continuing declines in life expectancy, raising questions about future trends in these countries.’ As far as the US is concerned, these trends reinforce its poor position in an international ranking of life expectancy among high-income countries (see table 1 below).
|Country||Life expectancy in years (average for men and women)/2015|
|14. United Kingdom||80.9|
|18. United States||78.9|
Source: Ho and Hendi (op.cit)
The recent mixed trends in life expectancy can be linked to deaths due to diseases associated with old age, such as respiratory and cardiovascular disease. In the US, a much-noted study by Nobel laureate Angus Deaton and his co-author Anne Case draws attention to the hitherto unknown case of white non-Hispanic Americans with limited education (no more than a high school degree) experiencing significant ‘increases in mortality and morbidity in mid-life since the turn of the century’. Proximate causes that could explain these negative trends include drug overdoses (often known as the ‘opioid crisis’), suicides and alcohol-related liver mortality – the so-called ‘deaths of despair’. Deeper structural factors include various types of social and economic dysfunction, such as the decline of marriage, social isolation and limited labour market opportunities. Case and Deaton lament that the story that they unearth is a tragic one ‘about the collapse of the white, high school educated, working class, after its heyday in the early 1970s…’ which continues unabated.