How long we all should live is like a weather gauge that measures the nation’s health climate. It’s known as “life expectancy” and should steadily increase from year to year when there’s no major events like war or epidemics. But not by much… progress depends on more people dying when they are older because of better treatments for age-related conditions.
If a country’s average life expectancy decreases, it rings alarm bells. Problems with healthcare services, poor lifestyle or social and economic adversity are some of the most likely factors at play.
New research published in the British Medical Journal this month shows many of the world’s wealthiest nations took a hit to life expectancy in 2014-15, probably due to a severe influenza season. The average decline was 0.21 years for women and 0.18 years for men.
While most countries recovered from this fluctuation the following year, the UK and USA did not rebound in 2015-16. Respiratory and cardiovascular diseases as well as nervous system and mental disorders were found to be largely responsible for the decline in life expectancy in the UK. More investigation is needed but certainly funding cuts to healthcare and social welfare programs as well as socioeconomic inequality issues top the list as prime suspects for drivers of the increased mortality observed.
The study found the USA was different from other high income countries. The decline in life expectancy in 2014-15 was concentrated on people under 65, whereas in other nations it was seen in older people. External causes, including drug overdose, and respiratory and cardiovascular diseases, contributed about equally to the decline in life expectancy in women. In men, nearly all the decrease in life expectancy was due to external causes and drug overdose. The USA now has the lowest average life expectancy (78.9 years) of 18 high income developed countries, more than five years less than Japan (84.0 years), which ranks first.
A separate study, also published in the British Medical Journal, investigated mid-life (age 25-64) mortality rates in the USA from 1999 to 2016 and found for the first time declining life expectancy regardless of racial group. The researchers cited drug overdoses, alcohol-related liver disease and suicides, together with organ diseases, as playing a major role in mortality rates, all pointing to systemic causes of declining health beyond the ongoing opioid epidemic in the USA. Opioids include the illegal drug heroin and pain relievers available legally on prescription, such as oxycodone, codeine and morphine.
What does all this gloom and doom tell us?
1. Vaccination against influenza and maintaining sufficient stocks of antiviral drugs such as Tamiflu are vital in protecting populations. Unfortunately, the flu vaccine in 2014-15 was a poor match to the predominant influenza strain that year, making it less effective. Countries known to be affected by influenza significantly (>10% life expectancy decline due to influenza) were: Austria, Belgium, Germany, Netherlands, Portugal, Sweden, Switzerland and UK. It is concerning that some modern healthcare systems in wealthy countries were unable to cope with the challenge posed in 2014-15 and could forewarn of bigger problems.
2. National and international agencies need to invest in good register based systems that allow timely and accurate monitoring of changes in life expectancy. Recent and reliable data is required to identify shared health threats sooner and support the development of policies. It took several years to identify the large number of high income countries simultaneously experiencing declines in life expectancy in 2014-15. Some countries have not released data yet for 2016.
3. More research is needed to understand the causes and provide possible solutions for declining life expectancy in the UK and USA.
While both research articles taken together suggest there may well be systemic causes for the decreasing life expectancy in the USA beyond opioid abuse, some policies that could help as far as drug use goes are: increasing access to substance misuse treatment programs, prescription drug monitoring programs, supervised injection centres and needle exchange programs, and increasing the availability of naloxone (used to block the effects of opioids). Such policies may be relevant for other countries that have reported recent increases in opioid prescriptions, including Australia, Canada, Denmark, Finland, Germany, Sweden, and the UK. Stronger scientific evidence will be vital in developing national and international polices that sustain progress in life expectancy and benefit the longer term health of populations.
Reversals in life expectancy in high income countries? Editorial British Medical Journal (2018)
Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics British Medical Journal (2018)
Recent trends in life expectancy across high income countries: retrospective observational study British Medical Journal (2018)
Why is US life expectancy falling behind? Visual Summary British Medical Journal (2018)