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Is Living Longer, Living Better?

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Image via karunabv.org

According to the World Health Organization (WHO), as of 2015, global life expectancy was 71.4 as measured at birth – 73.8 years for females and 69.1 years for males. But a new study published in The Lancet suggests that by 2030, women in South Korea could live, on average, to be as old as 90, followed closely by the women in France, Spain, and Japan. And among men, in places like South Korea, Australia, and Switzerland, the average will likely surpass 80 years.

Not surprisingly, however, of the 35 countries studied, specifically those higher income countries, the Unites States remained on the lower end of life expectancy, with smaller projected changes.

Of the lower numbers in the U.S., CNN’s Meera Senthilingam wrote that study authors suspect “there are many reasons for deaths in this age range including greater obesity rates and their associated health risks…lack of universal health care in countries like the U.S. is also thought to play a role.”

With the potential for repeal of the Affordable Care Act, the health care safeguards that help care for the aging and those with chronic disease could be in jeopardy. A paper published earlier this year in the New England Journal of Medicine points out that only 15 percent of 400 physicians randomly surveyed support complete repeal of the legislation. One of the papers’ authors, David Grande, MD, MPA, an assistant professor of Medicine and director of Policy at Penn’s Leonard Davis Institute of Health Economics, said “Tens of millions of people could be at risk of losing health insurance if critical elements of the Affordable Care Act are repealed.”

Other research has shown there is a correlation between access to care and health – and perhaps by association, lifespan – just as the researchers behind The Lancet study note a connection between socioeconomic status and health. And the risks are becoming more profound over time, with the increasing number of people who need care for serious illnesses throughout their lives.

“If you were born in the United States in 2000, you have a 33 percent chance of developing diabetes. African Americans are even more vulnerable than whites, and poor people are more at risk than the affluent,” said Mark Schutta, MD, medical director of the Rodebaugh Diabetes Center, in a recent Philadelphia Inquirer interview about an event during which his team performed blood glucose screenings and taught North Philadelphia middle schools students on health, nutrition, and the risks for diabetes.

The WHO lists diabetes as the sixth leading cause of death in the United States, trailing heart disease and stroke, which are both linked to diabetes. There is also more research that illustrates the connection between lower socioeconomic status and diabetes, obesity , related diseases, and total mortality – from work by researchers in Sweden to those in New Zealand to an earlier study by Carolyn Cannuscio, ScD, director of research at Penn’s Center for Public Health Initiatives, which found that material disadvantages – health care, food, and housing – were linked to declines in self-rated health, and participants experiencing several of these situations were susceptible to worsening health and functional decline. Of the results, Cannuscio and the co-authors wrote, “this study demonstrated the importance of considering health care, food, and housing as determinants of population health and health disparities…Older adults with multiple forms of material disadvantage were at particularly increased risk of health decline and functional impairment. Strategies to improve population health and to reduce health disparities must address a range of basic human needs, including affordable, quality health care, food, and housing.”

CNN’s take on the new Lancet study suggests that living longer is a good thing, particularly for those in Asian countries, where the elderly seem to experience fewer health problems – possibly in part due to the diet and exercise regimens, which Senthilingam also reported on for CNN in early 2016. But some experts suggest that there may actually be a benefit to earlier mortality.

For one, Ezekiel Emanuel, MD, PhD, chair of Medical Ethics & Health Policy at Penn Medicine, took to The Atlantic in 2014 to detail why living to be 75 years old may be the tipping point between a life well-lived and a life in physical decline. He wrote, “but here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived.”

As Emanuel also points out, other research has evaluated the impact of age on physical ability and mobility, by looking at whether people could complete specific tasks which are essential for independent living – for example walking quarter of a mile; climbing 10 stairs; standing or sitting for two hours; and whether some could stand up, bend, or kneel without using special equipment. Emanuel wrote that according to the study’s authors there was an “increase in the life expectancy with disease and a decrease in the years without disease. The same is true for functioning loss, an increase in expected years unable to function.”

It seems we may be at an impasse: In the next 15 years, people in the United States may be living longer, but based on socioeconomic disparities, trends in diabetes and obesity, and research showing that these extra years may just be riddled with disease and impairment.

However, as Senthilingam wrote “[the study’s author] believes the secret to South Korea's success has been the country's investment in childhood nutrition, education and technology as well as low blood pressure, low levels of smoking and good access to health care.” And as Schutta and his team did in North Philadelphia, the key to living longer – and living better – may lie in access, education, and preventative health measures.

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