Health Matters: A look at life expectancy

Q. I read recently that people with only a high school education have a lower life expectancy. Is that true?

A. In September, the New York Times and other news media reported a deeply disturbing story: life expectancy among white men and women in the U.S. with less than a high school education has declined steadily since 1990. For white women with less than a high school education, life expectancy dropped from older than 78 in 1990, to about 75 in 2000, and just older than 73 by 2008.

Why is this so disturbing? Life expectancy has been increasing in the U.S. for all groups for more than 100 years. Each generation has come to expect it will live longer than the previous. During the 50-year period from 1900 to 1950, the Centers for Disease Control and Prevention documents a striking improvement in life expectancy in the U.S.

A person born in 1900 could be expected to live, on average, 47.3 years. By 1950, life expectancy was 68.2 years, a 44 percent increase over 1900. This improvement in life span had not been exceeded in the U.S. in any previous period. In the latter half of the 20th century, longevity continued to increase for all groups. The decline found among people with low education starting in 1990 reversed this historical trend.

Because life expectancy had been continually increasing among all groups for more than 100 years, we have tended to forget improvement is not inevitable. Life expectancy is a measure of the health of a population, not an individual’s health. For individuals, life expectancy is a probability, not a certainty. An individual within a population may live longer than expected or die before the expected age, but the average (or expected) age indicates the common situation affecting that population’s health.

The story in the Times reminds us that life expectancy, that is, expected longevity for a group of people, results from conditions that affect the entire group, and if these conditions change for the worse, life expectancy will change for the worse as well. In the 1950s when we believed that antibiotics had eliminated microbial disease threats, René Dubos, the Pulitzer Prize–winning microbiologist, warned that new microbial diseases would always arise. In the 1980s, Dubos was proved correct by the AIDS epidemic and others like H1N1 that followed. Today, the finding that life expectancy has declined for whites with low education sounds a similar warning.

There are several lessons that we should take away from the story about the recent decline in life expectancy among Americans with low education. Life expectancy fluctuates like the stock market or any other dynamic phenomenon. We cannot assume it will continually improve without our involvement.

In every era, we must determine what the threats to continued improvements in health and longevity are. We need to monitor health, detect trends and their causes, disentangle the multiple factors that affect health and longevity, seek solutions and evaluate the comparative effectiveness of our strategies. We should not “drop the ball” handed to us by our ancestors who, as the result of their foresight and investments, left to us the health and longevity benefits that we enjoy today. We should continue their robust work and leave an equally fine legacy.

This calls for investment in scientific tools, methods and training, not complacency. Creating large, integrated data sets for data mining and predictive modeling, developing advanced computational and statistical methods applied to both population health and medical care problems are two examples. These kinds of investments will tell us what we are doing wrong, what we are doing right, and what we could do better to improve health and longevity.

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Goldsteen is director of the UND School of Medicine and Health Sciences Master of Public Health degree program, which is jointly offered with NDSU. He has devoted most of his professional life to advancing public health and holds a doctorate in public health.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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