Longer Lives, Sicker People?

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Golden Ages, like most any mythic memory, are less about the past than about the present and a set of ideological guidelines meant to transform it. Tradition sanctifies. If it is alleged that some herbal medicine has been used for thousands of years, then it is thought it must have some efficacy that modern medicine cannot match. After all, that which is of ancient vintage has not only survived the test of time but has the added virtue of being closer to nature. The presumed superiority of all things natural is the flip side of the belief that the food supply in affluent societies is contaminated and part of the larger conviction that modern life is unsafe.

Rarely is the question raised: If contemporary life is so polluted with "chemicals" and other products of modern life, if our food is so lacking in nutrition, if our pharmaceuticals so worthless, why are we living so long? Like Diogenes with his lamp looking for an honest man, I have been seeking an answer or at least someone to attempt an answer to this question. Why are we living so long? Not only are the more affluent of us living longer and healthier, the same is increasingly true for the poor in developed and some developing countries. "Medical advances have not only lengthened life expectancy but have also reduced its variance in the developed world," which means that the poor in developed countries have improved both their absolute and relative wellbeing (May 2001, 891). Further, in the early nineteenth century, "a typical British male worker at maturity was about five inches shorter than a mature male of upper-class birth," a gap that has been reduced to about an inch today, simultaneously with the narrowing of the life expectancy gap (Fogel 2000, 143-144).

Still Ill

Authors gain fame by finding novel ways to find fault with the present. The data on the achievements of modern life are so overwhelming life expectancy, infant mortality that a scholar seeking to gain recognition by finding fault must come up with clever ways to explain those gains away. One rather ingenious author has argued that since we live longer and are older, we "have more time at risk to ill health" (Riley 1989, 215). In fact, among older Americans whom Riley deems to "have more time at risk to ill health," there has been a "dramatic" decline in chronic disability, according to the National Long Term Care Survey, as reported in a 1997 study by the National Academy of Sciences (PRB 1997, 3). Data from both developed and developing countries increasingly shows that those who live the longest tend to have the lowest percentage of their lives with what they self-define as a disability. In recent years, the DALY (disability-adjusted life years) for Americans has been rising even faster than life expectancy, and for developing countries the emerging data hints at the possibility that each year of increase in life expectancy adds at least a year and maybe more of disability-adjusted life years.

To his credit, Riley has moderated his earlier, more categorical assertions that longer life means more time in ill health, but he cannot quite let go of the idea, as the following quote indicates: "Modern medicine has reduced mortality by adding months or years of life for people who, in earlier times, would have died from intractable ailments. That effect adds to sickness time. The prevalence of morbidity increases because more people survive their diseases for longer periods. In some cases the added survival time occurs when the malady is still active and disabling. But in many cases modern medicine has found ways to manage disease, restoring a person to an active life" (Riley 2001, 107).

Why the reluctance to admit that for public health, the Golden Age is now?

Thomas R. DeGregori is a professor of economics at the University of Houston and the author of the recent book The Environment, Our Natual Resources, and Modern Technology (Iowa State Press: A Blackwell Publishing Company) and a forthcoming book, Origins of the Organic Agriculture Debate (Iowa State Press: A Blackwell Publishing Company), both of which formed the basis of much of the material in this paper.


References

Fogel, Robert W. 2000a. The Fourth Great Awakening & The Future of Egalitarianism. Chicago: The University of Chicago Press.

Fogel, Robert W. 2000b. The Extension of Life in Developed Countries and Its Implications for Social Policy in Twenty-first Century, Population and Development Review (Supplement), 26:291-317.

May, Sir Robert. 2001. Risk and Uncertainty: At the Frontiers of Science, We Don't Always Know What May Happen, Nature 411(6840):891, 21 June.

PRB. 1997. Chronic Disability Declines Dramatically Among U.S. Elderly, Population Today: News, Numbers, and Analysis. Population Reference Bureau 25(9), September.

Riley, James C. 1989. Sickness, Recovery and Death: A History and Forecast of Ill Health. Iowa City: University of Iowa Press.

Riley, James C. 2001. Rising Life Expectancy: A Global History. Cambridge; New York: Cambridge University Press.