History repeats itself: life expectancy falters with the rise of social + economic inequality

This end-of-year episode of The Big Middle is devoted to history – the past repeating itself when it comes to life expectancy.

When you set a Google news alert for life expectancy as I do – it’s a core issue of The Big Middle – you can’t help but notice an uptick in the number of articles about it. The headlines are all variations of UK and US life expectancy stalls are worse than most other rich countries.

We’re still living so much longer than ever before – 81 is the UK average, 79 in the US. The average was 69 in both countries as recently as 1950. Over the last century, every generation has been living ten years longer than the one before.

But you can get lost in a fog of numbers and percentages and projections in the growing crop of articles about the slowing pace of life expectancy gains. And the clashing opinions from influential pundits on why it’s happening.

In search of clarity and context, I speak with Simon Szreter, a Cambridge University professor of history and public health. A self-styled egalitarian, he’s a global leader in making sense of historical public health data.

He says we’ve been here before, several times. In England, average life expectancy fell from 43 years in the 1500s to the low 30s in the 1700s.

History teaches us, he says, that universal healthcare and education are among the interventions that matter when it comes to life expectancy, not high levels of GDP per capita. The European Union has a higher life expectancy than the United States, with 40% less income. Prof Szreter says the fact we’ve been labouring for decades under the illusion of capitalism has “brought us to this absurd position of sitting on a melting planet waiting for the next carbon-using toy.”


On GDP as key driver of life expectancy gains in UK+US: “[History] shows us that simply relying on economic growth to deliver widely-distributed good health to the population is not good enough. It has to be accompanied by government policies that address how to use that economic growth and wealth. If you simply leave it to the free market to decide, inevitably…some people will get left by the wayside, some will self-harm, some will become extremely poor and some will experience premature immortality and that’s what we’re seeing right now.”

“Economic growth creates wealth and resources but the big question is who’s getting them and how are [they] being used. Are they being cashed out in Lear jets and yachts and investments in enormous blocks in London and Paris and New York – where sometimes people don’t even live -…or is it going into people’s lives…funding their education and training and enabling them to function in this society sufficiently and earn a living.”

“We need policies where we’re all in it together.”

On the climate crisis: “..biggest problem facing the world” “..requires the kind of response that governments found possible when faced with global fascism in the late 1930s and 40s.“ “They found it within their political willpower to come together and tax themselves heavily and fight this dreadful threat to their existential survival. We have exactly this threat now. It needs that scale of response. And that kind of response is a world away from free markets and libertarianism and free choice and requires a whole level of coordination and integration from citizens and governments working together.”

On social care: “We need a system to provide good quality social care which accepts that it’s expensive but the alternative is a kind of lottery where old people are scared that they’re going to bankrupt their families and sell their house and deal with themselves when they don’t know what’s going on.”

On education: “Every single citizen should have three years of government-funded educational training post secondary school at any point in their lives.”


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