Pick Your Health Crisis: Medical Stagnation or Death Shortage?

Amid the judicial news about Obamacare, the Los Angeles Times reports a study that deserves more attention in the months ahead.

"[S]ubstantial strides have been made in dealing with the consequences of disease," [USC gerontologists Eileen Crimmins and  Hiram Beltran-Sanchez] wrote, noting that people live longer with serious illness. But even life expectancy increases may be nearing an end, they wrote.

"We have always assumed that each generation will be healthier and longer lived than the prior one," they said. "The growing problem of lifelong obesity and increases in hypertension and high cholesterol among cohorts reaching old age are a sign that health may not be improving with each generation. . . We do not appear to be moving to a world where we die without experiencing disease, functioning loss, and disability."

And in a USC press release Crimmins elaborates:

"The increasing prevalence of disease may to some extent reflect better diagnostics, but what it most clearly reflects is increasing survival of people with disease," Crimmins said. "The cost of maintaining and providing care for people with chronic conditions is an important part of determining the economic well-being of countries with established social security and government-provided health services."

Historians of medicine have been noting related trends dating back to the 19th century. As medicine became more effective in preventing death from acute conditions, it (and other trends like changing diet and sedentary living) began to increase the proportion of the population with chronic conditions. See James C. Riley's Sickness, Recovery, and Death, based on Victorian "friendly society" records.

Of course there have been distinguished people on the other side of the question, like the demographer James Vaupel, who (when I last heard him speak at Princeton three years ago) predicted that the "plasticity of longevity," the steady continued expansion of the human lifespan, would continue its reassuring upward march. Here's an interview from 2004, and on the downside, a 2006 warning from The Atlantic about the perils of the "coming death shortage."

If the extension of the human lifespan, and the outlook for healthier old age, really are stalled, it's a bigger story than all the world's health insurance legislation. And if the trend that Crimmins and Beltran-Sanchez noted is real, we shouldn't count on economic recovery to reverse it. There's even evidence that the Great Depression had a net positive effect on the nation's health, and that economic expansion might make things worse.