13 January 2021

As life expectancy falls, we watch the one true miracle of the modern world slipping away from us

We have experienced a tiny taste of the kind of mortality that was once inevitable.

It’s rare for historical trends to follow a straightforward narrative of progress, but life expectancy was, until recently, one of the few exceptions. In England and Wales in 1841, life expectancy was 40.2 for men and 42.2 for women; 180 years later, both figures had roughly doubled.

Life expectancy was historically depressed primarily as a result of very high childhood mortality rates. In a remarkable study from 2013, the academics Anthony Volk and Jeremy Atkinson examined data from a wide range of geographic locations, cultures and time periods and estimated the levels of both infant mortality (death before the age of one) and child mortality (death before the age of 15). They found that, before the 20th century, in cultures as different from each other as Roman Egypt and Edo-era Japan, the two figures hovered at around 25 per cent and 45 per cent respectively, with surprisingly little variation. This was, it seems, the natural and terrible rate normally suffered by our species.

But then, if we plot Volk and Atkinson’s figures on a graph and look to the far right, we see something wondrous: both lines suddenly fall precipitously, and keep falling. Even in the poorest parts of the world today, the mortality risk to children in the 21st century is a tiny fraction of what it once was, and in the West the risk is infinitesimal. This is truly a miracle of the modern world.

But humans can get accustomed to anything, even miracles. In Britain, for example, childhood mortality rates that graze zero have come to be expected, and curing infectious disease among children no longer presents a route towards further increasing life expectancy. Meanwhile, even as cures have been found for diseases that were once lethal for adults, new lifestyle illnesses have emerged to take their place. So out with tuberculosis and smallpox, and in with diabetes and atherosclerosis. Technological development isn’t saving us any more – it does the opposite, since cheaper food and less manual labour combine to produce illnesses previously only suffered by gouty kings. Meanwhile, social atomisation and disintegration are leading to “deaths of despair” by suicide or addiction, disproportionately suffered by the poor.

This one, precious example of historical progress – that lives are becoming longer – is now slipping away from us. The rate of improvement in overall life expectancy started levelling off at the beginning of this century, and in poorer areas in Western countries we have, for the first time in many decades, witnessed a decline. Covid-19 has accelerated the fall, with a recent study by researchers at Oxford University suggesting the pandemic has cut life expectancy in England and Wales by roughly one year. Ridhi Kashyap, one of the authors of the study, said in December that the pandemic “will have implications for how soon we are able to get back to the trajectory of progress that we had seen in life expectancy”.

It’s an interesting phrase, “get back to the trajectory of progress” – so very optimistic, and so very vulnerable to disappointment. In the Christmas issue of this magazine, John Gray wrote of the “great humbling” brought on by a crisis that has traumatically revealed “the fragility that lies at the bottom of our way of life”. It turns out that a scrap of genetic material in a protein coat can bring our highly developed, technologically interconnected society to its knees. In fact, coronavirus has hurt our society so badly, in part, because our society is so highly developed.

Usually, maps of the world designed to show the spread of human misery (highlighting rates of childhood mortality, say) follow the same pattern: sub-Saharan Africans suffer most, followed by those in the Middle East and South Asia, with the West the least affected. Covid 19 death rates reveal almost precisely the opposite pattern, which is exactly what we should expect given that the age-mortality graph for this infectious disease looks less like a typical U-shape – killing both the very young and the very old – and more like a hockey stick. In England and Wales, the mean age of people who have died of Covid-19 is 80.4, with more than 90 per cent of victims aged 65 or older (only 3 per cent of sub-Saharan Africans fall into this age range, in contrast to almost 20 per cent of the English population).

In previous centuries, a disease that mostly killed the elderly might have gone unremarked. There were no ventilators or oxygen tanks available to offer to the sick, and in a society in which almost half of children routinely died, our ancestors didn’t have much attention to spare for a disease that is nothing like as lethal as cholera or bubonic plague.

But, unlike our ancestors, most of us now live well into old age because we are kept alive (though sometimes only just) by modern medicine. And we all expect, quite rightly, that the NHS will step in to treat us when we become ill, and that doctors will use every means necessary to save our lives, with no form of treatment either rationed or withheld.

Comparisons with pandemics of the past, and in particular the endless use of the word “plague”, miss the point about the Covid crisis, which is in reality extremely modern. We have a large population of frail, elderly people because our medical system is so advanced, and we are prepared to take extreme measures to prevent loss of life because we are not used to those people, or anyone, dying from infectious disease. We have experienced a tiny taste of the kind of mortality that was once inevitable, and have been unpleasantly reminded that, far from getting “back to the trajectory of progress”, the task we are now faced with is to resist being tugged back to the human norm.