Life Expectancy and Intergenerational Justice

David Kingman argues that no-one should be blamed for the fact we’re all living longer, but society has got to prepare for it

 

On Wednesday 8 June the Guardian printed an interactive map showing how life expectancy varies across Britain.

While nearly all the accompanying commentary focused on the spatial variations between different areas, and the fact that – as it sadly does in most countries – how long you can expect to live seems to correlate with your wealth, the bigger picture went rather unnoticed.

British longevity

 

This is, to put it straightforwardly, that almost anyone born in Britain can expect to live for an astonishing length of time, compared to most other countries in the world today, and to any period in our past.

According to the CIA World Factbook, which ranks countries by life expectancy in a table, the typical British person born today can expect to live 80.5 years (for women it’s even better, as they tend to live a couple of years longer than men). Research by the Department for Work and Pensions in 2010 suggested that nearly 1 in 5 people will be over 100 by 2066.

As Andrew Marr said at the end of his History of Modern Britain series, ‘to be born British is still a remarkable stroke of luck’; something which is definitely true when comparing life expectancy here to what it is in other countries. The UK comes in at 28th place in the table, which may actually seem a little low, but this is misleading for two reasons:

1) Disproportionate ranking of very small countries: Life expectancy seems to correlate negatively with population, as a number of the top-ranked countries are small-island nations or urban micro-states, which perform disproportionately well in such rankings because it’s easier to deliver health services and reduce environmental health hazards for a small population living in a compressed geographical area.

You can see this from the fact that the top four countries are, in order; Monaco, Macau, San Marino and Andorra. Of the 27 countries that have higher life expectancy than the UK, 12 are so small they have a combined population of just 1.4 million, which is lower than Greater Manchester.

If you only included the countries containing more than 5 million people, a population large enough to present substantial obstacles to the delivery of health care, then the UK would have the 13th highest life expectancy in the world.

2) Tiny differences between countries: If you only include the large countries, then the differences between them become very marginal; Japan, rated 5th overall, is the large country that is furthest ahead of the UK, where the average person can expect to live 2.2 years longer than they do here.

No other country containing above 5 million people is more than two years ahead of Britain, and in only nine other countries do people live more than a year longer than they do in the UK, on average. These differences should not be taken lightly by individuals – to a family, every extra day they have with a much-loved relative will seem precious – but at the statistical level, the distinction is fairly minimal. What it means is that in no other large country do people live substantially longer than they do in the UK.

It’s worth bearing in mind that the difference between Japan and Britain seems truly irrelevant when compared to countries at the lower end of the scale. People born in Angola, the nation that comes bottom of the CIA’s ranking, have a life expectancy of just 38.76 years.

However, the most striking fact of all is the shockingly low percentage of the world’s population which has the opportunity to live as long as people in Britain do. The UK, and the countries which have longer life expectancy, account for just 8% of the people in the world – the remaining 92% will enjoy substantially fewer years of life, on average, than we do here.

This shows what an exclusive privilege it is in global terms to have the typical life expectancy of someone born in the UK, and how, even though this is likely to cause us an increasingly number of problems in the coming years, we shouldn’t forget how fortunate we are as individuals.

A potted history of life expectancy

 

When discussing longevity one could almost echo Harold Macmillan’s famous expression, as we’ve genuinely ‘never had it so good’. No one can be certain of how high life expectancy was in the UK before about the 19th century, although it would have been many years lower than it is today. Some historians have suggested an average of about 35 years from birth in the Middle Ages, although this doesn’t mean no one lived beyond this age.

When thinking about life expectancy, people often commit the fallacy of assuming it means the age at which everyone dies. What you have to remember is that it is an average, meaning half the population, will tend to live longer – so in the Middle Ages, infant mortality (people dying before they reach 5) would have been very high, killing off between a quarter and half of all live births. However, if you could make it through to adulthood without being struck down by a disease or dying violently then you had a very good chance of surviving to your 50s or 60s. Life expectancy remained low because the weight of early deaths dragged the average down.

Gradual advances in medicine, such as the smallpox vaccine invented by Edward Jenner in 1796, and improved nutrition led to a steady rise in life expectancy, so that it had reached 47 for a man and 50 for a woman by 1900. One colossally important development was the construction of sewerage systems, which made it harder to catch the many water-borne diseases that were responsible for large numbers of infant deaths.

The story during the subsequent 111 years has been one of consistent, almost exponential increase, so that the average figure has risen by over 61% in this period. New vaccines have been developed, alongside new treatments for diseases such as cancer which give people much better odds of survival. Despite recent worries about lifestyle health threats such as obesity and heavy drinking, the general healthiness of the way people have lived actually improved during the 20th century; they gradually smoked less, ate healthier food, and breathed cleaner air. Most importantly, infant mortality has been reduced to fewer than 5 in every 1,000 births, so the vast majority of children now navigate their vulnerable first few years successfully.

Perhaps the most important milestone was the creation of the NHS in 1948, which made life-extending healthcare available for the first time to millions who couldn’t previously afford it, although publically-funded healthcare can’t be the whole explanation: South Korea, for example, has an almost entirely privately-funded system, but life expectancy there increased by even more during the 20th century.

The consequences of higher life expectancy

 

High life expectancy is at the heart of the need for greater intergenerational justice. In the past, people simply didn’t have to think about fairness between different generations, as there were fewer generations alive at the same time.

Now several different generations all claim a slice of Britain’s national pie at once. Pensions can be seen in the biggest intergenerational issue of all as the swelling ranks of the elderly demand to be fed and watered at the younger generation’s expense.

Yet it’s important to remember that the story of the looming crisis in public and private pensions is a curious tale with no real villain. Indeed, all that has changed to disrupt the previous arrangement is a development which is entirely positive on its own, and has brought great enjoyment to many individuals and families; simply, the fact that people are living longer.

The general problems with people living longer are felt directly by society, and only indirectly by families and individuals. As life expectancy galloped ahead during the 20th century, a tacit acceptance sprang into place between voters, politicians and the business world that all the extra years should be extensions to retirement, seen as a kind of taxpayer-funded holiday that should increase exponentially in length. Only recently has society woken-up to the inherent unsustainability of this arrangement and begun to move away from it, by trying to get people to spend some of their extra longevity in the workplace and make higher individual contributions to their pensions. While this has been a positive step, none of the proposed reforms go far enough to give the younger generation a fair deal in terms of the number of pensioners they will have to support in retirement – and within the political realities of what’s possible, the difficulties of legislating even for small changes mean it’s likely that the bulk of the baby-boomer generation will retire with most of the old arrangements still largely in place.

The group which comes closest to fulfilling the role of villain in this story are members of the actuarial profession. They were charged with ensuring public- and private-sector pension funds would have sufficient assets to support their members; however, gains in life expectancy were continually underestimated, meaning virtually all pension funds now lack sufficient assets to  fulfil the demands being made on them.

However, it’s hard to argue that even they should have seen this coming, as the extent to which life expectancy has risen is so unprecedented. Simply put, in the 50,000-year history of the human race, no population of Homo Sapiens has ever lived as long as people in developed countries are living now. In the financial world, the prediction of what will happen in the future is usually based on an analysis of what has happened in the past. Can actuaries and accountants really be blamed for not predicting a phenomenon which has never occurred before?

Population ageing is a slow process, but the lack of previous action to address it means that society is quickly and messily having to catch up now. For example, the forthcoming summer showdown between the government and a coalition of public-sector unions over pensions is really a dispute about life expectancy: the government has realised that it can’t afford to support all these workers under the present arrangements because of how much longer their retirements are going to be than they were in previous generations, while the unions dig their heels in over maintaining the status quo.

This is only the beginning; a recent report from the Organization for Economic Cooperation and Development argued that by 2050 Britain will have to spend an additional £80 billion pounds a year on pensions, the NHS and long-term care, despite the fact that pensions already account for 18% of government expenditure.

The 1946 post-war spike in the birth rate means that 800,000 people will turn 65 in 2012 alone, and the insidious thing about this trend is that it proceeds slowly, with the number of retired people increasing by so many thousand each year. The government has already had to start spending nearly £14 billion a year more on pensioners since the first baby boomers started retiring in 2005, and this large bulge will have added another £4 billion by 2012; the government, and by extension the younger taxpayers underwriting it, are on a treadmill and they will have to run faster and faster just to maintain the same output.

These are the unfortunate consequences of us all being able to live longer. To reiterate, it is no one’s fault that this happening; not the medical profession, not the government’s and not the individuals who have had years added to their lives. Very few people, barring the minority who end their lives voluntarily through suicide and euthanasia, actually chose how long they get to live. Yet it is causing huge changes which our society must adapt to – and in doing so, it must make sure the rights of the younger generations aren’t ignored.

Posted on: 21 June, 2011