Healthy Life Expectancy Is Expanding.

This is a very complex issue given that the issue involves many factors, including genetics, socioeconomic status, culture, and the quality and availability of healthcare services. Furthermore, it is not easy to define many of the above elements (e.g., culture, quality). Even if we could, determining the individual effects of components that we know can influence healthy life expectancy (HLE) (to say nothing of those “unknown unknowns”) is exceedingly complicated, but we do know some things that can help address the question. First, although it may sound absurdly obvious, most of us prefer to be alive than dead—at almost any age and no matter what our health status. Life expectancy is increasing at all ages in the developed world and has been for quite a while. As well, the rates of being alive and the number of those who manage to reach old age (i.e. who do not die prematurely) surely reflect some of the great successes of public health over the last 150 years. That being said, how exactly are we supposed to define the “healthy” component of HLE? Despite the greater number of morbidities that members of older adults experience on average, there is still a U-shaped curve, with a rising sense of psychological well-being from middle age into old age. In this case, who are we (usually relatively young academics) to say that an elderly person who “suffers” from hypertension, osteoarthritis, or stable heart disease or may have recently undergone cancer chemotherapy, but who feels better than a younger counterpart (or than he himself did when still climbing the curve) is not as “healthy” as the younger person ?” Beyond these philosophical questions, do we have any hard data? There are some. As alluded to above, in most parts of the world, over the last 150 years, life expectancy has been on a continuous rise. In addition, increases in life expectancy have been consistently underestimated over the last 150 years. Malthus, who lived to only 68, is probably rolling over in his grave for having made the first of many overly pessimistic forecasts by actuaries. Other more modern demographically minded Cassandras have warned of rising elderly dependency ratios—defined as the number of those who have reached state pension age divided by the number of working-age (16–64) adults. This ratio is meant to estimate the proportion of older persons to those who “pay for them.” For the moment, let us ignore the fact that, at least in the more developed regions of the world, many older persons are paying their own way out of previous savings and pension investments. With an increasingly healthy older population, many of whom will continue to work, especially in the developed world, a “real elderly dependency ratio” has been calculated. Reassuringly, at least for England and Wales, it predicts stabilization out to 2050, hardly consistent with an increasingly disabled older population. So far, the pessimists have been proven wrong, and their continuing negative prognostications may well continue to be ill founded. When life expectancy and HLE fall, such as is the case, for example, in the post-Communist former Soviet Union or more recently for white, non-Hispanic Americans, these decreases are largely due to treatable conditions such as drug and alcohol abuse, suicide, and chronic liver disease, all of which have recrudesced largely for social and economic reasons. This deterioration is especially evident in less-well-educated individuals. The fact that these indices deteriorate when people abuse their health (at least in part as a result of social dislocation and socioeconomic disparities) or are denied equitable and reasonable health services suggests that, in the absence of such negative factors, people will be more likely to age in reasonably good health. In support of this notion, it appears that initiating a “healthy” lifestyle (the earlier the better), even at an older age (≥70), can have a beneficial effect on life expectancy. Even if we are living longer, are we experiencing less “age-related” disease? Happily, it appears that, for many common, devastating conditions, such as heart disease and dementia, the answer is mostly positive. Because older people are generally sicker than their younger counterparts and the absolute number of older persons is rising throughout the world, the prevalence and From the Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-sheva, Israel.