Life expectancy has lengthened, but not equitably

Part of a series.

For most of recorded human history, lifespans did not change.

Life expectancy doubled in the twentieth century. At the time of Lincoln the average life span was 38 years; today it is about 78 to 80 years. But whenever it ends it is like a waterfall. Most people begin to die near to the expected point; the drop off in percentage still living declines precipitously. Fortunately, the waterfall has been pushed downstream by years and decades but eventually, the time arrives.

Like a slow moving river, we go through life in our 20s, 40s and even 60s with little concern or thought about death. Then almost suddenly we realize it is fast approaching. Can we as individuals push our personal waterfall further downstream? The answer is yes but to do so effectively requires starting back when we were not really thinking about it — as young adults or even better as children.

Why have life spans increased? Many would credit better medical care, and certainly, that has had a significant role, especially for the individual person. But most of the effect comes from public health: decreased maternal mortality at childbirth, reduced infant mortality, reduced childhood infection mortality due to vaccines, and greatly reduced deaths due to infections such as typhoid fever and tuberculosis as a result of safe water and sewers along with pasteurization of milk. More people have better nutrition and better housing. As to medical care, antibiotics are the prime example of an improvement that had a major impact on early mortality as has care of those with trauma. In other words, deaths that used to occur in infants, children and young adults are largely curtailed today with most deaths now occurring in just the older age groups and usually due to chronic illnesses — illnesses that for a large measure are related to a lifetime of adverse behaviors.

Longevity varies by location. Baltimore, Maryland is a good example. For a person born in 2011, it is estimated by the CDC that the average lifespan will be about 72 years. But the variability based on location within Baltimore of that birth is striking. A person, likely white, born in an affluent neighborhood will live on average to 83 years. A child, likely black, born in a socially economically distressed area will die on average by age 63. Longevity varies by sex, race, location and many other factors but in the end, it is only partly due to genetics, somewhat due to environment and very much due to how we treat our bodies over time. Of course, a person in a poor neighborhood has less access to good food, finds it unsafe to let the kids out to play, is chronically stressed just dealing with the bare necessities of life and is barraged with advertisements for tobacco and alcohol while drug dealers abound on the corners and violent trauma is commonplace. So it is not necessarily chosen behaviors but a lifestyle of necessity that determines variations in longevity.

Before launching into the specifics of aging and how we can age gracefully, perhaps we should not take aging too seriously as suggested by this poem (by English poet Rose Milligan; first published on September 15th, 1998 in the 21st edition of The Lady, England’s longest running magazine for women).  Or at least we should appreciate that some things are important in life whereas others might well be set aside in favor of the former.

Dust if you must, but wouldn’t it be better
To paint a picture, or write a letter,
Bake a cake, or plant a seed;
Ponder the difference between want and need?

Dust if you must, but there’s not much time,
With rivers to swim, and mountains to climb;
Music to hear, and books to read;
Friends to cherish, and life to lead.

Dust if you must, but the world’s out there
With the sun in your eyes, and the wind in your hair;
A flutter of snow, a shower of rain,
This day will not come around again.

Dust if you must, but bear in mind,
Old age will come, and it’s not kind.
And when you go (and go you must)
You, yourself, will make more dust.

Crisis-2 jpegStephen C. Schimpff is a quasi-retired internist, professor of medicine and public policy, former CEO, University of Maryland Medical Center, and senior advisor, Sage Growth Partners.  He is the author of Fixing the Primary Care Crisis: Reclaiming the Patient-Doctor Relationship and Returning Healthcare Decisions to You and Your Doctor.

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