Raising Life Expectancy and Expectations

In recent years, we have seen a considerable rise in life expectancy around the globe. Yet, there can be no broad-spectrum answer to interventions to increase the life expectancy of men and women across geographies, ages and income brackets. To strengthen public health delivery, we will need to pay even closer attention to data and better assess risks.

In the US, in the view of Professor Angus Deaton of Princeton University, progress has stagnated due to what he call “deaths of despair” among the middle-aged population – drug overdose, suicide and alcoholism. In contrast, across less-affluent countries, a key priority should be the reduction of child and infant mortality.

Saira Afzal Tarar, Minister of State for National Health Services, Regulations and Coordination of Pakistan, said that her country is facing very different challenges – lowering maternal and child mortality, restructuring infrastructure and attempting to provide care to those earning less than $2 a day. With the success of previous policies – which have effectively added four years to the average life expectancy of a Pakistani citizen, her priorities have shifted to a new objective – namely, tackling heart disease.

Across todays’ societies there is substantial focus on “heroic” medicine and new biotechnology. Yet, that is not the only frontline along which progress will be made. There is sizable need to deliver affordable medicine across the world. On partnering with UNICEF to deliver maternal and neonatal medication, Kenneth C. Frazier, Chairman and Chief Executive Officer of MSD, said he has witnessed enormous inefficiency in healthcare systems, which, in his assessment, is the largest hurdle.

Experts agree on the need to reframe care infrastructure. One piece of the puzzle is the consistent provision of a universal health system, needed for citizens in the United States as much as for those in Pakistan. In Pakistan, 50% of people will drop below the poverty line due to healthcare costs. In the US, improvements to universal health access over the past year reduced mortality by 6%. In the 1960s, Australia had a similar life expectancy to the US today, and was able to shift the needle in part through providing universal healthcare.

There is a strong economic imperative to address longstanding issues with the health system. When a person is sick, they lose the ability to generate an income, highlighted Professor Deaton. Health systems that deliver positive results also help preserve people’s income and income opportunities.

Much of what needs to be accomplished to increase life expectancy is to change habits and behaviours, alongside providing access to healthcare. Overall, experts agree that the core priority should be a shift to better primary care. The key barrier to longer, more fulfilling lives appears to be people’s inability to think about their health across a longer time horizon and, specifically, to realize the benefits of behaviour change in nutrition, screening and medication.

What if the new horizon of medicine is not advances in biomedical research, but the implementation of better community and behaviour-driven approaches to teaching people about preventative medicine (including nutrition)? Perhaps we need systems, not biological innovation.