In most places in the world, the death rate keeps falling. Even in the West, where we keep doing our best to tempt fate by gaining more weight, the trend continues to be toward longer life. Now some scientists believe the rapid growth of genetic knowledge may make further medical breakthroughs even more likely. How much longer might we live? And how will society cope if we do?
Obesity, penicillin-resistant infections, AIDS, global warming—when it comes to public health, there is plenty to be alarmed about. Yet in spite of everything, death rates are actually falling.
If this trend continues—and it seems likely that it will, as it’s being driven by a variety of factors—experts say there may be some difficult adjustments ahead.
The falling death rate
For the 10th year in a row, the Centers for Disease Control (CDC) announced in March that U.S. mortality rates had fallen. In 2009, the year for which the center’s most recent statistics are available, mortality fell by 2.9 percent, to 741 per 100,000. Death rates fell for 10 of the 15 leading causes of death.
Heart disease declined by 3.7 percent, cancer by 1.1 percent, lower respiratory diseases by 4.1 percent, and strokes by 4.2 percent. Accidents/unintentional injuries, Alzheimer’s, and diabetes all fell by 4.1 percent. Influenza and pneumonia declined by 4.7 percent, followed by septicemia (1.8 percent). Even homicide dropped, by 6.8 percent.
Overall, the numbers suggest that it’s probably not as late as you think. In 1961, the average baby in the United States could be expected to live to 67.5. Today, life expectancy at birth is 78.3. This trend is not peculiar to our time. Duke University demographers Jim Oeppen and James W. Vaupel pointed out in 2002 that the outer limits of life expectancy had increased consistently over the prior 160 years. The researchers noted that in 1845, Sweden topped global life expectancy charts with an average female life expectancy of 40. Now the country with the longest-living women is Japan, where women live to a little over 86, more than double that old record.
In their paper, published in the journal Science, Oeppen and Vaupel found that although the lead country changed, life expectancy at the top rose about 2.5 years per decade. At the same time, they say that all along the way, demographers have almost always underestimated the possibility of extending life expectancies.
And there is still a lot of room for improvement, particularly for Americans: the United Nations ranks the United States 36th in life expectancy. Japan is the leading major country, with life expectancy at birth now 82.6. Iceland, Switzerland, Spain, and France all outpace the United States. Even residents of the United Kingdom, home of the deep-fried Mars Bar and the bacon sandwich, are expected to last a year longer than the typical American, 79.4 years to the American’s 78.3.
What’s driving the advances?
The CDC says that one-third of the population in the United States is now obese. Many other countries are getting fatter, too, even France, where nearly 12 percent are now classified as obese, compared with 8.7 percent in 1997, according to a recent survey by Roche, the Swiss pharmaceutical company. So how is it that we keep getting better at outrunning the Grim Reaper when we should be waddling into an earlier grave?
Advances in science are undoubtedly the largest component, but one source of gains in recent years has been perhaps less technical than organizational.
For example, Abdul I. Barakat, director of research at the Hydrodynamics Laboratory (LadHyX) and Department of Mechanics in the Ecole Polytechnique of Palaiseau, France, is working on improvements in stents, the small metal wideners that help open clogged arteries.
That’s not unusual. Plenty of medical researchers have done heart-related research for years. After all, heart disease is one of the leading causes of death in most developed countries. What might seem more surprising is that Professor Barakat isn’t a doctor. He’s an engineer.
Not so long ago, few people without a medical background would have been involved in such research. Now, it’s much more common. “Over the past 20 years or so, things have really changed dramatically,” Barakat says. “Doctors, I find now, are very open to involving engineers, physicists, and basic biologists in the whole enterprise. There’s a huge interaction that’s going on now, and that’s benefiting everybody.”
Such collaborations seem promising. One area that Barakat and other researchers are working in now that most point to as a source of huge potential is nanotechnology, the emerging ability to manipulate materials on a molecular and even atomic scale, which creates many new possibilities for medicine. Doctors may be able to install sensors that can monitor in real-time what your body is doing, like tiny versions of the engine sensors in your car. Also looming are small, implantable medical devices that could correct problems earlier than doctors can now.
Another potential source of fruitful future collaboration that seems to show some promise for physical health is psychology. Working with data culled from the lives of 1,500 people who were tracked from the age of 10 on, two psychology professors from the University of California at Riverside, Howard S. Friedman and Leslie Martin, found that certain personality traits seemed to correlate with longevity. Sociability and conscientiousness are two such traits. Worrying helps, too, the professors say, particularly among men, as worriers tend to be more careful with their health.
We may also have some out-and-out medical breakthroughs ahead, particularly in gene-related diagnosis and treatment. Although gene therapy hasn’t lived up to the hype yet, genes are being sequenced thousands of times faster than they were just a few years ago, thanks in part to faster computer processing, so the rate of acquisition of genetic information continues to increase.
Less gold for those golden years?
So if most of us do end up living longer, what will our golden years look like? Unfortunately, perhaps, not quite like those investment advertisements of silver-haired senior citizens out laughing on the beach.
One of the risks of these medical advances is that being alive and living well can be different things. Some fear that a prolonged period of life in physical pain or dementia could be one of the side effects of the declining mortality rate. “Although by age 65 almost 9 out of 10 of us can expect to have some kind of chronic condition, we’re now far more likely to be living with it than dying of it,” says Olivia S. Mitchell, a professor of insurance and risk management at Wharton and executive director of the Pension Research Council.
Longer life may also entail some hard choices for individuals, families, and society. As quick early deaths are being replaced by longer, lingering ones, death is becoming less something that simply happens to you and more and more a choice.
“The real issue is whether morbidity will continue to track mortality, that is, will people continue to be productive and work longer for the same fraction of their lifetimes,” says Kent Smetters, a professor of business and public policy at Wharton. “If yes, then I say longevity is a good thing. But if we are only keeping people alive on the drip then we will have to ask ourselves if that’s the type of life we want to live (I would not) and publicly support with high taxes during the limited working years.”
Even if much of that time is relatively healthy, it will still lead to massive changes in society. It may also become unfeasible for people to retire in their middle 60s, the age Americans now think of as the normal retirement age.
“Traditional old-age programs like Social Security and Medicare, already stressed to the breaking point, will grow much more expensive and will be rendered unaffordable,” says Mitchell.
In a way, society would be going back to the future. “At the turn of the 20th century, people never retired—they just worked till they dropped,” Mitchell says. “Looking ahead, it won’t be economically feasible for everyone to retire in their early 60’s (as Americans now do) if they will live to 120. It’s just too costly for individuals, their families, and society to pay for.”
The health-care challenge
Health care costs would likely be another big challenge. As nations age, they tend to spend more. The United States already spends 16 percent of its GDP on health care compared with 6.6 percent in 1969, according to the Organization for Economic Cooperation and Development (OECD). Other OECD countries have also experienced a similar long-run rise in the percentage of GDP devoted to health care, if at a much more sustainable level. Japan spent 4.6 percent of its GDP on health care in 1969. Today it spends 5.9 percent, according to OECD figures. In 1969, France spent about 6.3 percent. Today, it spends 11.8 percent.
Earlier interventions in health are also likelier, such as discouraging smoking or encouraging weight loss, simply because the payoffs to society are greater if that long old age is a healthy one, Mitchell says.
Longevity would have many consequences for business, too. For instance, “sales of traditional ‘life’ insurance (really death insurance) will fall, but demand for annuities (lifetime payout products) will rise, along with demand for long-term care coverage,” she predicts.
Much longer life spans would also require a massive reengineering of our social systems. “School will not be something that only children do—instead, we must construct life-long retraining/reskilling to help workers keep up with changes in the modern economy,” Mitchell says.
Keeping up with the times is likely to be a challenge for many workers. One reason is technical obsolescence. In a world of rapid change, the premium on wisdom declines.Another reason is simply prejudice. Even as the corporate world talks about the virtues of inclusiveness, tolerance for the older worker isn’t especially high. Major personnel companies such as Manpower keep forecasting that companies will soon have no choice, demographically, but to hire additional older workers. For now, however, older workers do often have a hard time getting hired. In fact, many of today’s leading companies tend to not have many gray heads anywhere, and particularly not further up the corporate ladder.
At the top, for example, C-level tenure is often relatively short. The average chief marketing officer of a top U.S. consumer brand is out after 42 months, according to a survey by Spencer Stuart, the human resources consultancy. A second survey, conducted by Booz & Company, another consultancy, found that CEOs last around five years.
Way down the line, some entirely unfamiliar challenges could also arise. If genetic engineering grows widespread, Lee Silver, a Princeton molecular biologist, fears that the current health gap between rich and poor might widen, divided between those who can afford to have themselves not only repaired but improved—a group that Silver calls GenRich—and the genetically poor.