We're No Longer Making Much Progress on Life Expectancy Gains

Yesterday I discussed the claims by Hong Kong that it has the highest life expectancy at birth in the world. Every country would undoubtedly like to be in the running for that honor as long as it means that we are all on an upward trajectory. Back in December, I noted that U.S. life expectancy had gone down for the second year in a year, after reaching a record high in 2009. Of course, even at the time of that record high, the U.S. lagged behind every other rich country in the world with respect to life expectancy, despite having the highest per person health care costs of any nation in the world.

The slowdown in the U.S. life expectancy trajectory is, unfortunately, not too far different from the global pattern. Thanks once again to Todd Gardner for pointing to a story on WebMD summarizing a recent paper published by Carolina Cardona and David Bishai, both of whom are in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. Bishai is well qualified on these topics, having a PhD in Health Economics, along with an MD and MPH, and Cardona is a PhD student of his. They provide a concise summary of their analysis:

New technological breakthroughs in biomedicine should have made it easier for countries to improve life expectancy at birth (LEB). This paper measures the pace of improvement in the decadal gains of LEB, for the last 60-years adjusting for each country’s starting point of LEB.

LEB increases over the next 10-years for 139 countries between 1950 and 2009 were regressed on LEB, GDP, total fertility rate, population density, CO2 emissions, and HIV prevalence using country-specific fixed effects and time-dummies. 

Contrary to the expectation that advances in health technology and spending would hasten improvements in LEB, we found that the pace-of-growth of LEB has slowed around the world.

The WebMD article adds a bit of background to this:

They [Cardona and Bishai] said the slowdown in life expectancy gains does not mean that humans have simply reached their maximum biological life span. Rather, the researchers argue that their findings could mean that recent medical advances have not sustained historic increases in average life expectancy.

"This is not about us hitting the ceiling," researcher David Bishai said in a Hopkins news release. "The slowdown has been sharpest in countries that have the most life expectancy to gain."

"It's a rebuke to the idea that you can fix global health just by inventing more stuff," he said. "New health technology has been essential to making strides in life expectancy, of course, but our predecessors in the 1950s were making faster progress with the basics of soap, sanitation and public health."

This latter point is one I have tried to make emphatically in my book. The big gains in life expectancy in the world have come from a combination of public health science and medical science. Both are important and countries have to invest in both in order to keep people alive longer.